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J 15056051058 REV-1500 EX (06-05) PA Department of Revenue OFFICIAL USE ONLY Bureau of Individual Taxes County Code Year File Number PoBDX2aosot INHERITANCE TAX RETURN -- Harrisburg, PA 17128-0601 RESIDENT DECEDENT 21 09 ' 1153 ENTER DECEDENT INFORMATION BELOW Social Security Number Date of Death - Date of Birth 235-42-9282 ! ; 11/23/2009 _ _ _ _ _ 02/06/1923 Decedent's Last Name - _ ._.. Suffix Decedent's First Name Guilles _ _.. _. __ _ MI Mary M (If Appllcable) Enter Surviving Spouse's Information Below Spouse's Last Name Suffix Spouse's First Name __ MI _ .._ _. Spouse's Social Security Number __ _ _ _ __ _ __ __ THIS RETURN MUST BE FILED IN DUPLICATE WITH THE - - REGISTER OF WILLS FILL IN APPROPRIATE OVALS BELOW C~ 1. Original Return C~ 2. Supplemental Retum C":.:9 3. Remainder Return (date of death ~:..~ 4. Limited Estate prior to 12-13-82) r,~5 4a. Future Interest Compromise (date of 5. Federal Estate Tax Return Required death after 12-12-82) C1a 6. Decedent Died Testate t~...`~ 7. Decedent Maintained a Living Trust 0 (Attach Copy of Will) _........ _ 8. Total Number of Safe Deposit Boxes (Attach Copy of Trust) G~ 9. Litigation Proceeds Received C~ 10. Spousal Poverty Credit (date of death t 11. Election to tax under Sec. 9113(A) between 12-31-91 and 1-1-95) (Attach Sch. O) CORRESPONDENT - THIS SECTION MUST BE COMPLETED. ALL CORRESPONDENCE AND CONFIDENTIAL TAX INFORMATION SHOULD BE DIRECTED TO: Name - Daytime Telephone Number Robert L. Knupp, Esq. -- - - (717) 238-7151 Firm Name (If Applicable) ~~ - ~ REGISTER OFt9Bq~ USE ONLS~ -, ~ Hupp Law Offices, LLC -; ~• , First line of address ~ ? -fir` ~j ~ _.. _ .. _....__ ...._......_.... ~._ P.O. Box 630 ~ ~ ~ _. _ _ Second line of address - ~ - --~- .. , C~ ~: ~ ~,. -.,. ; 407 North Front Street ' ~ "~'' .~ ,_, ---~ -_ ~ _; ~-i __ _.. _.. City or Post Office _ - State ZIP Code ~ _.._. DAtE FILED W ` --.~ arrisburg _ ~'' __ _ _ PA 17108 Correspondent's a-mail address: Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct and complete. Dedaraticn of preparer other than the personal representative is based on all Information of which preparer has any knowledge. SIGNA RE PERSON RES ONSIBL R FILING RETURN ~ DATE DR SS ~ % Lou Ann Guilles 128 Melbourng Lane, Mechanicsburg, PA 17055 SIGf~____ OFi6t7FCeooo7nT~~ar~...., ______ DATE ADDRESS . ~ ~ ~ 1~ Flowers & Flowers, CPAs, 5775 Allentown Blvd., Suite 102, Harrisburg, PA 17112 (717)652-6564 PLEASE USE ORIGINAL FORM ONLY 15056051058 Side 1 15056051058 15056052059 REV-1500 EX Decedent's Social Security Number Decedent's Name Mary M Gullies 235-42-9282 RECAPITULATION ~" ~._. 1. Real estate (Schedule A) . .......... .............................. .... 1. 2. Stocks and Bonds (Schedule B) ........ ........................... .. 2. 297,708.72 3. Closely Held Corporation, Partnership or Sole-Proprietorship (Schedule C) .... 3, 4. Mortgages & Notes Receivable (Schedule D) ..... _ _. ............. . ...... .... 4. 5. Cash, Bank Deposits & Miscellaneous Personal Property (Schedule E) 5 .... .... . 46,885.34 6. Jointly Owned Prope ~ 9 q rty (Schedule F) C,~,~ Separate Billin Re uested 6 ... 7. Inter-Vivos Transfers & Miscellaneous Non-Probate Property (Schedule G) .... . 13,210.69 Q Separate Billing Requested.... .... 7 185,873.65 8. Total Gross Assets (total Lines 1-7)....... ... . ~,...~_. ....~....~..~.~_..~,~, ~_.~~~. ~ .... .......... ~a.~.. ~~_.. ~a~~._ .. 8. 543,678.40 Funeral Expenses & Administrative Costs (Schedule H) T-_ _... ~. _ ~..~.~ ._,... ~.m~ _.._.. ... . .......... . 9. 36,237.99 10. Debts of Decedent, Mortgage Liabilities, & Liens (Schedule I) .......... 10 ... .. . . 29,616.91 11. Total Deductions (total Lines 9 & 10) .. ............................. 11. 65,854.90 12. Net Value of Estate (Line 8 minus Line 11) .. .. . ....... . 13. Charitable and Governmental Bequests/Sec 9113 Trusts for which 12 477,823.50 an election to tax has not been made (Schedule J) ..................... .. . 13. , 2,000.00 14. Net Value Subject to Tax (Line 12 minus Line 13) . ... . __~..__._._~~_____.~______.~.._~..__._..~._._~..~._._~... _...._.. ................ TAX COMPUTATION -SEE INSTRUCTIONS FOR APPLICABLE RATES _ _ ... 1a. ~~ ~~ ".___~...___ 475,823.50 .~ ~ "~' ~ __.""°"~"~" ~~-`~--- 15. Amount of Line 14 taxable at the spousal tax rate, or transfers under Sec. 9116 (a)(1.2) X .0_ 16. Amount of Line 14 taxable 15. at lineal rate X .0 45 464,269.96' ., 17. Amount of Line 14 taxable 1s. 20,892.15 at sibling rate X .12 10,553.54 18. Amount of Line 14 taxable 17. 1,266.42 at collateral rate X .15 1,000.00: .... 18 150.00 19. TAX DUE ........ _. .. ............................................... .. 19. 22,308.57 20. FILL IN THE OVAL IF YOU ARE REQUESTING A REFUND OF AN OVERPAYMENT ~, 15056052059 Side 2 15056052059 REV-1503 EX+ (6-98) SCNEDVLE B COMMONWEALTH OF PENNSYLVANIA STOCKS & BONDS INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary M. Guilles FILE NUMBER 21 09 1153 All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM NUMBER DESCRIPTION VALUE AT DATE ~' CNB Financial Corp (CCNE), Nasdaq, 420 SH Com, Cusip 126128 10 7 OF DEATH Mean value on D.O.D.= $16.97/SH (see attached documentation) No ex-dividends. 7,127.40 2. FirstEnergy Corp. (FE), NYSE, 564 SH Com, Cusip 337932 10 7 Mean value on D.O.D. =$42.30/SH (see attached documentation) No ex-dividends. 23,857.20 3. Motors Liquidation Co. (MTLQQ), OTC, Formerly General Motors Corp., 100SH Com, Cusip 370442 10 5 Mean value on D.O.D. _ $ ,67/SH 67.00 4. Halliburton Co. (HAL), NYSE, 8,000 SH Com, Cusip 406216 10 1 Mean value on D.O.D. = 30.55/SH (see attached documentation) No ex-dividends. 244,400.00 5. Idearc Inc (IAR), NYSE, 26 SH Com, Worthless, (see attached documentation) 0.00 6. Johnson & Johnson (JNJ), NYSE, 50 SH Com, Cusip 478160 10 4 Mean value on D.O.D.= $62.76/SH (see attached documentation) 3,138.00 7. Johnson & Johnson (JNJ), Ex-dividend 11/20/2009, $.49/SH, Payable 12/8/2009 24.50 8. Tractor Supply Co. (TSCO), Nasdaq, 50 SH Com, Cusip 892356 10 6 Mean value on D.O.D.= $48.44/SH (see attached documentation) No ex-dividends. 2,422.00 9. Verizon Communications Inc. (VZ), NYSE, 538 SH Com, Cusip 92343V 10 4 Mean value on D.O.D.= $30.99/SH (see attached documentation) No ex-dividends. 16,672.62 (If more space is needed, insert additional sheets of the same size) TOTAL (Also enter on line 2, Recapitulation) I $ 297,708.72 REV-1508 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT ESTATE OF Mary M. Guilles SCHEDULE E CASH, BANK DEPOSITS, & MISC. PERSONAL PROPERTY Include the proceeds of litigation and the date the proceeds were received by the estate. All property jointlyowned with right of survivorship must be disclosed on Schedule F. ITEM JMBER DESCRIPTION 1. Cash on Hand at D.O.D. 2. PNC Bank -checking Acct# 51-4002-5253, Balance @ D.O.D. non interest bearing (Bank statement & confirmation letter attached) 3. PNC Bank -premium MM Acct# 50-0439-6121, Balance @ D.O.D. $27,921.90 + $10.46 accrued interest (Bank statement & confirmation letter attached) 4. Susquehanna Valley Federal Credit Union - Acct# 55-00 Regular Shares, Balance @ D.O.D.= $59.28 (Bank statement & confirmation letter attached) 5. Susquehanna Valley Federal Credit Union - Acct# 55-10 Life Savings Insurance Shares, Balance @ D.O.D.= $4,000.00 + $3.53 accrued interest. (Bank statement & confirmation letter attached) 6. 1999 Lincoln Town Car, Excellent condition with 18,900 miles, Kelley Blue Book -private party good condition value = $6,175.00. (see attached) Sold 2/26/10 for $6,500.00 7. Commonwealth of PA - PSERS pension for November 2009 received 11/30/09 after D.O.D. 8. Allstate Insurance -Homeowner's insurance refund 9. NEA Insurance Trust -refunds 10. PA Dept of Revenue -refund on Decedent's final 2009 PA income tax return Form PA-40 11. U.S. Treasury -refund on Decedent's final 2009 Federal income tax return Form 1040 12. National Geographic -refund FILE NUMBER 21 09 1153 VALUE AT DATE OF DEATH 46.00 6,201.00 27, 932.36 59.28 4,003.53 6,500.00 1,499.14 194.10 13.47 102.00 317.00 17.46 Note: Decedent, Mary M. Guilles moved to Messiah Village, Mechanicsburg, PA on 5/22/09 as an assisted living resident. Her health status continued to deteriorate and she was unable to function in any capacity with regard to her personal care or affairs. All her household goods, furniture, personal effects were sold or disposed of prior to the sale of the residence on 11/17/09 and prior to D.O.D. Proceeds from any sales were deposited into Decedent's personal accounts. Any items gifted were of insignificant value. Any personal effects remaining as of the D.O.D were also of insignificant value. TOTAL (Also enter on line 5, Recapitulation) S 46.885.34 tlr more space is needed, insert additional sheets of the same size) REV-1509 EX+ (6-98) COMMONWEALTH OF PENNSYLVANIA INHERITANCE TAX RETURN RESIDENT DECEDENT CCTATC Ae SCI~iED~1LE F JOINTLY-OWNED PROPERTY Mary M. Guilles FILE NUMBER 21 09 1153 If an asset was made joint within one year of the decedent's date of death, It must be reported on Schedule G. SURVIVING JOINT TENANT(S) NAME ADDRESS RELATIONSHIP TO DECEDENT A. Patricia A. Sollenberger B' John N. Herbert C. Fred W. Guilles, Jr. 12 Lincoln Drive Fayetteville, PA 17222 100 South 12th Street Huntingdon, PA 16652 128 Melbourne Lane Mechanicsburg, PA 17055 JOINTLY-OWNED PROPERTY: ITEM NUMBER LETTER DATE FOR JOINT MADE TENANT JOINT DESCRIPTION OF PROPERTY INCLUDE NAME OF FINANCIAL INSTITUTION AND BANK ACCOUNT NUMBER OR SIMILAR IDENTIFYING NUMBER. ATTACH DEED FOR JOINTLY H 1. A. 10/01/04 - ELD REAL ESTATE. Susquehanna Valley FCU -Syr Certificate, Acct# 55 -9921, Purchased 10/1/09 by rollover of Syr Certificate Acct# 55-5568 maturing 10/1/09. Both certificates were held jointly with Sister, Patricia A. Sollenberger. Balance @ D.O.D.= $10,000.00 +$53.53 accrued interest. (Copy of Bank statement, certificates & confirmation letter attached) 2' B 10/01!04 Susquehanna Valley FCU -Syr Certificate, Acct# 55 -9920, Purchased 10/1!09 by rollover of Syr Certificate Acct# 55-5569 maturing 10/1/09. Both certificates were held jointly with Brother, John N. Herbert. Balance @ D.O.D.= $10,000.00 +$53.53 accrued interest. (Copy of Bank statement, certificates & confirmation letter attached) 3. C/D 04!14/06 Susquehanna Valley FCU -Syr Certificate, Acct# 55 -6583, Certificate issued 04/14/2006 & held jointly with Grandson, Fred W. Guilles, Jr and Granddaughter, Shannon N. Marciano. Balance @ D.O.D.= $9,399.83 + $71.61 accrued interest. (Copy of Bank statement, certificate & & confirmation letter attached) Sister Brother Grandson OF DATE OF DEATH DATE OF DEATH DECD'S VALUE OF IALUE OF ASSFT iurroocr ~.-,..-.,~.,_......___. 10,053.53 ~ 50 10,053.53 ~ 50 9,471.44 ~ 33 TOTAL r on line 6, Recapitulation) S 5,026.77 5, 026.77 3,157.15 13.210.89 tlr more space is needed, insert additional sheets of the same size) SCHEDULE F (Continued) Jointly-Owned Property Estate of: Mary M. Guilles File Number 2l 09 1153 Surviving Joint Tenants Name (Continued) D. Shannon N. Marciano / 122 Juniper Drive, Etters, PA 17039 /Granddaughter REV-rsio Ex+ fos-ny) Pennsylvania SCHEDULE G °EPARTMENr o` REVENUE INTER-VIVOS TRANSFERS AND INHERITANCE TAX RETURN MISC. NON-PROBATE PROPERTY RESIDENT DECEDENT ESTATE OF Mary M. Guilles FILE NUMBER 21 09 1153 This schedule must be completed and filed if the answer to any of questions 1 through 4 on page three of the REV-1500 is yes. ITEM DESCRIPTION OF PROPERTY NUMBER INCLUDE THE NAME OF THE TRANSFEREE, THEIR RELATIONSHIP TO DECEDENT AND DATE OF DEATH I THE DATE OF TRANSFER. ATTACH A COPY OF THE DEED FOR REAL ESTATE. VALUE OF ASSET °1o OF DECD'5 EXCLUSION TAXABLE I. PNC Bank, Performance checking Acct# 50-0505-9485 B l INTEREST iIFAPPUCaaLE> VALUE , a ance @ D.O.D.= $151,231.89 + $11.11 accrued interest. Account opened 6/9!2009 and held jointly with Daughter-in-Law, Lou Ann Guilles. (Bank statement & confirmation attached) 151,243.00 50 3,000.00 148,243.00 2 Midland National Life Insurance Co. -Annuity Contract #8500176079 Issued 4/9/04, Beneficiary: Lou Ann Guilles, Daughter-in-law, (D.O.D. value documentation attached) 37,630.65 TOTAL (Also enter on Line 7, Recapitulation) $ 185,873.65 If more space is needed, use additional sheets of paper of the same size. REV-1511 EX+ (12-99) SCHEDULE H COMMONWEALTH OF PENNSYLVANIA FUNERAL EXPENSES & INHERITANCE TAX RETURN ADMINISTRATIVE COSTS RESIDENT DECEDENT ESTATE OF Mary M. Guilles FILE NUMBER 21 09 1153 Debts of decedent must be reported on Schedule I. ITEM NUMBER DESCRIPTION A• FUNERAL EXPENSES: AMOUNT ~' Musselman Funeral Home, 324 Hummel Avenue, Lemoyne, PA 17043 7,615.03 2. The Bricker House -Facility rental plus funeral reception 585.16 s. Rolling Green Cemetary -Headstone & flag poles 2,345.00 B. ADMINISTRATIVE COSTS: 1 • Personal Representative's Commissions Name of Personal Representative(s) Social Security Number(s)/EIN Number of Personal Representative(s) Street Address City .State Zip Year(s) Commission Paid: 2. Attorney Fees 15,200.00 3. Family Exemption: (If decedent's address is not the same as claimant's, attach explanation) Claimant Street Address City State Zip Relationship of Claimant to Decedent 4. Probate Fees 501.50 5. Accountant's Fees 9,750.00 6. Tax Retum Preparer's Fees 7. The Sentinel -Legal advertisement 166.30 a. Cumberland Law Journal -Legal advertisement 75.00 TOTAL (Also enter on line 9, Recapitulation) I $ 36,237.99 (If more space is needed, insert additional sheets of the same size) REV-1512 EX+ (12-08) Pennsylvania DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT SCHEDULE I DEBTS OF DECEDENT, MORTGAGE LIABILITIES & LIENS ESTATE OF Vlary M. Guilles FILE NUMBER Report debts incurred by the decedent prior to death that remained unpaid at the date of death, including nre mbursed medical ITEM NUMBER expenses. DESCRIPTION VALUE AT DATE 1' Messiah Village -October 2009 statement: assisted li i OF DEATH v ng and nursing care charges 17,686.00 2. UGI -final bill for residence 8.66 3. PP&L -final electric bill for residence 17.33 4. American Water -final bill for residence 10.37 5. Lawn care for October 2009 -check cleared after D.O.D 96.00 6. Verizon -final phone service bill 13.53 ~ West Asset Management Inc. - Decedent's final credit card statement 381.16 $. Messiah Village -November 2009 Statement: assist d li i e v ng and nursing care charges 10,046.50 9. Alert Pharmacy, Inc. 608.26 10. Messiah Village -final invoice 696.00 11. Alert Pharmacy, Inc. 53.10 TOTAL (Also enter on Line 10, Recapitulation) g 29,616.91 If more space is needed, insert additional sheets of the same size. REV-1513 Ek+ ;11-C18) j Pennsylvania ~' DEPARTMENT OF REVENUE INHERITANCE TAX RETURN RESIDENT DECEDENT tJ1Alt OF Mary M. Guilles SCHEDULE BENEFICIARIES NUMBER NAME AND ADDRESS OF PERSON(S) RECEIVING PROPERTY I TAXABLE DISTRIBUTIONS [Include outright spousal distributions and transfers under Sec. 9116 {a) (1.2).] 1. Lou Ann Guilles, 128 Melbourne Lane, Mechanicsburg, PA 17055 2. Shannon N. Marciano, 122 Juniper Drive, Etters, PA 17039 3. Fred W. Guilles, Jr., 128 Melbourne Lane, Mechanicsburg, PA 17055 4. Patricia A S II b 5. 6. II 1. o en erger, 12 Lincoln Dnve, Fayetteville, PA 17222 John N. Herbert, 100 South 12th Street, Huntingdon, PA 16652 Tony Ortiz, P.O. Box 659, Carrizozo, New Mexico 88301-0659 FILE NUMBER 21 09 1153 RELATIONSHIP TO DECEDENT AMOUNT OR SHARE Do Not List Trustee(s) nF FcTnrc Daughter-in-Law Granddaughter Grandson Sister Brother Nephew 8.00%of remainder 46.00%of remainder 46.00%of remainder 5,526.77 5,026.77 1,000.00 ENTER DOLLAR AMOUNTS FOR DISTRIBUTIONS SHOWN ABOVE ON LINES 15 THROUGH 18 OF REV-1500 COVER SHEET, AS APPROPRIATE. NON-TAXABLE DISTRIBUTIONS A. SPOUSAL DISTRIBUTIONS UNDER SECTION 9113 FOR WHICH AN ELECTION TO TAX IS NOT TAKEN B. CHARITABLE AND GOVERNMENTAL DISTRIBUTIONS 1. St John Episcopal Church, 212 Penn Street, Huntingdon, PA 16652 (See Will: THIRD Sec, Item D) 1,000.00 2. Hospice of Central Pennsylvania, 17 East HighStreet,Carlisle, PA 17013 (See Will: THIRD Sec, Item E) 1,000.00 TOTAL OF PART II -ENTER TOTAL NON-TAXABLE DISTRIBUTIONS ON LINE 13 OF REV-1500 COVER SHEET. $ 2,000.00 If more space is needed, insert additional sheets of the same size. Estate of: Mary M. Guilles D.O.D. 11-23-2009 File No. 21-09-1153 ATTACHMENTS TO: Pennsylvania Inheritance Tax Return Form REV-1500 ccr+n,+~N~+.~ra~rN c~ FENNSV€:~,~r~ia - CEGA«FT~*dFNT Cry AEYE?tVz. f~E 1.'-1151 EXtI t-~6~ BUaEtU :^r tNul w~i Dpi AC 'ax FS ~~~'~ 23v6~<1 H,~f7~1~3JFiG. aA 37`2?-w56i RECEIVED FROM: PENNSYLVANIA INHERITANCE ANC ESTATE TAX OFFfCIAL RECEIPT GUILLES LOU ANN 128 MELBOURNE LANE MECHANICSBURG, PA 17055 ACN ASSESSMENT AMOUNT CONTROL NUMBER - -- ,,,., TOTAL AMOUNT PAID: REMARKS: CHECK#1013 SEAS INITIALS: CJ RECEIVED BY: ~ 21, 000.00 GLENf7A EARNER STRASBAUGN REGISTER OF WILLS TAXPAYER aRIGINAL DILL IN "AFB OF KNUP~9 KODA~~ dMDL~~ LAST WILL AND TESTAMENT ' p~C` OF MARY MARGARET GUILLES f, MARY MARGARET GUILLES of the Borough of New Cumberland, Cumberlaned County, Pennsylvania, being of sound and disposing mind, hereby make, publish and declare this my Last Will and Testament, hereby revoking and making void ali prior Wills and other testamentary writings at any time heretofore made by me. FIRST: l direct my Executrix or successor Executrix, hereinafter named, to pay all of my just -debts, funeral and testamentary expenses as soon as conveniently can be done after my demise. SECOND: "Since Bill and son, Fred, are gone, I must make a new will to dispose of my property in the event of my death. "My maternal Grandfather, John M. Baker, who resided in Clearfield County, Pennsylvania, amassed a moderate fortune after leaving school very young and working in the mines to support his mother and five sisters. In his wi[I, he wrote that his wealth should fast through future generations. It was divided between his three daughters. I then inherited a share of my mother's inheritance and then later a share of my Aunt Bessie's who had no children. Now, when I die, I would Pike my grandchildren, SHANNON N. GUILLES and FRED W. GUILLES, JR., to inherit equally my stocks. These assets in stocks were derived from my inherited stocks. "I would hope that my grandchildren will cherish these stocks in order to pass them on to their children." THIRD: I give, devise and bequeath: (A) All of my household goods and personal property to my daughter-in-law, LOU ANN GUILLES; (B) The sum of Five Hundred Dollars ($500.00) to my sister, PATRIC(A H. SOLLENBERGER; (C) The sum of One Thousand Dollars ($1,000.00) to TONY ORTIZ of Carrizozc, New Mexico; (D) The sum of One Thousand Dollars {$1,000.00) to my church, ST. JOHN'S EPISCOPAL CHURCH in Memory of Fred and h7ary Herbert and Bili and Mary Margaret Guilles and son, Fred Guilles, Sr. (E) The sum of One Thousand Dollars ($1,000.00) to HOSPICE OF CENTRAL PENNSYLVANIA, INC. (F) I request that my grandchildren, SHANNON N. GUILLES AND FRED W. GUILLES, JR. shall visit the gravesite of theirfather and grandparents as many times as it is convenient, after my death and shall see to it that the gravesite is maintained during their lives or the survivor of them. FOURTF': All the rest, residue and remainder of my estate whatsoever kind and wheresoever situate, unto LOU ANN GUILLES, SHANNON N. GUILLES AND FRED W. GUILLES, JR., in the following shares: (A) One-third (1/3) of the remainder of my estate, but not including any portion of any stocks that I own at the time of my demise, I give, devise and bequeath to LOU ANN GUILLES. It is my intent that her share shall be one-third (113) of the total value so fong as the stocks .are not included in her share. (B) Two-thirds (2/3's) of the rest, residue and remainder of my estate shall be given to LOU ANN GU{LEES in trust for the benefit of SHANNON N{COLE GUILLES AND FRED W. GUILLES, JR. This share of my residual estate shall iiiclucle the shares of stock held in my name at the time of my death. FIFTH: The Trustee hereinabove named shall: (A} Hold, manage, invest and reinvest the trust fund for the benefit of said FRED WILLIAM GUILLES, JR. and SHANNON NICOLE GUILLES (hereinafter referred to as "the Beneficiaries"), and shall collect the rents, interest, dividends and other income therefrom and after deduction of all proper charges and expenses shall, from time-to-time or at any time during the minority of the beneficiaries, pay or apply to or for the use of the beneficiary all or so much of the net income therefrom and principal thereof, including, but not byway of limitation payments or applications for the support, maintenance and education of the beneficiary of Trustee, in their sole discretion shall deem necessary or advisable; such payments or applications may be made by the Trustee directly or by paying such income or principal to a guardian ofthe children's person with whom the beneficiary may reside at the time of such payment, in every case without requiring any bond, and the receipt of such .guardian of the person with whom the beneficiaries may reside shaft constitute a full and complete discharge to the Trustee for any payment so made by her; and -the Trustee shall, during the minority of the beneficiaries, accumulate the surplus net income not so applied and the resu{ting income from such accumulations by investments as the Trustee is hereinafter authorized to rr~ake until the beneficiaries shall attain the age ~f forty (40) years, whereupon the Trustee shall transfer, pay over and deliver the principal of the trust fund as then constituted and any accumulated income to the beneficiaries absolutely. (B) fn the event that any beneficiary shall die prior to attaining the age of forty (40) years, then upon such death the principa[ of the trust fund as then constituted and any accumulated income shall be transferred, paid over and delivered by the Trustee to the executor or administrator of the beneficiary to become and be disposed of as a part of his/her estate. (C) The Trustee shall have, with respect to both principal and income of the trust fund and any additions thereto, the following powers, authorities and discretion without limitation by their specifications and until the actual distribution thereof: 1. To retain any such property without regard to the proportion such property or similar property held may bear to the entire amount held, and whether or not the same is of the class in which fiduciaries are authorized by law or any rule of court to invest funds; 2. To sell any such property upon such terms and conditions as may be deemed proper at either public or private sale, either on credit for such period of time as may be deemed proper or for cash, and with or without security and the purchaser of such property shall have no obligation to see to the use or application of the proceeds of sale; to exci~;ange, lease, sublease, mortgage, pledge or otherwise encumber such property upon such terms and conditions as may be deemed advisable; to grant options for any of the foregoing and to make any lease, or sublease, including any oil, gas or mineral lease, for such period of time and to include therein any covenants or options for renewal as may be deemed proper without regard to the duration of any trust and without approval of any court; 3. To invest and reinvest in and to acquire by exchange property of any character, foreign or domestic, or interests or participations therein, including by wayof illustration but not of limitations, real property, mortgages, bonds, notes, debentures, certificates of deposit, capital, common and preferred stocks and shares or interests in investment trusts, mutual funds or common trust funds, without regard to the proportion of any such property or similar property held may bear to the entire amount held and whether or not the same is of the class in which fiduciaries are authorized by law or any rule of court to invest funds; 4. To hold any personal property in any state; to register and hold any property of any kind, whether real or personal, at anytime held hereunder in the name of a nominee or nominees; and to take and keep anystocks, bonds or other securities unregistered or in such condition as to pass by delivery; 5. To employ in the exercise of absolute discretion investment cou<<sel, accountants, depositaries, custodians, brokers, attorneys and agents irrespective of whether any person so employed shall be a fiduciary hereunder or a firm or corporation in which a fiduciary hereunder shall have an interest and to pay them the usual compensation for their services out of the principal or income of the property held hereunder in addition to and without diminution of or charging the same against the commissions or compensation of any fiduciary hereunder; and any fiduciary who shall be a partner in any such firm sha(I nevertheless be entitled to receive his share as partner of the compensation paid to such firm. (D} This trust shalt be construed, regulated and governed in all respects as to administration and validity and affect by the laws of the Commonwealth of Pennsylvania and its sites shall be Cumberland County, Pennsylvania. (E} This trust shall continue for the benefit of the named beneficiaries anti! the younger beneficiary attains the age of forty (40) years, at which time the Trustee shall distribute his/her share to him/her or, if deceased, to his/her heirs outright, and upon completion of -final distributions this -trust shall terminate. SIXTH: Should there be any property of whatsoever kind and wheresoever situate of which (have the right to dispose at the time of my death, including but not limited to any special or genera[ power ~f appointment or both, 1 hereby appoint the same to my legatees set forth in Paragraphs THIRD hereof. SEVENTH: tt is my desire that my Personal Representative consult with Robert L. Knepp, Esquire of the law firm of Knepp, Kodak & Imblum, P.C., concerning the settlement of my estate since he has acted as my legal advisor and is acquainted with my affairs. EIGHTH: I nominate, constitute and appoint LOU ANN GUILLES as Executrix of this, my Last Will and Testament and further direct that she shall serve without bond. NINTH: !f the said LOU ANN GUILLES is for any reason unable or unwilling to serve as Executrix of this, my Last Will and Testament, then I nominate, constitute and appoint PATRICIA H. SOLLENBERGER, as successor Executrix. She, too, shall serve without bond. TENTH: Said Executrix or successor Executrix shall have the power to discharge all the debts, (lens and encumbrances upon my estate, as wet( as any taxes thereon, to pay for the cost of the final disposition of my remains and final illness, if any, to receive any and ali commissions and other comper~sation fir services rendered by me during my lifetime and to perform any and all fiduciary duties authorized by statute. Further, I direct my Executrix or successor Executrix to preserve my estate and any instructions pertaining to the distribution of the same from any attachment or anticipation while in the hands of my said personal representative, it being my express intent that all legacies shall be free from any attachment or anticipation while in the hands of the accountant for my estate. ELEVENTH: In the event that LOU ANN GUILLES is unable to serve as trustee of the testimentary trust established hereinabove, or she resigns as trustee, I appoint Fulton Bank as her successor trustee. T1h~ELFTH: "I have had a good life but I have sorely missed Bill and Fred. I leave with fond memories and respect for all my forebears. I also have a love for the members of Bill's family; most of whom live in the western states. Please let them know of my death. It was wonderful to have known them al[. Of course, Pat and John and their families were a special part of my life. "Please neverforget us, Bill and Mary Margaret and ourdearson, Fred." IN WITNESS WHEREOF, f have to this, my Last Will and Testament, typewritten on eleven (11) pages of paper, set my hand and seal at the end thereof this /,~ day of (/~,,._%,,. ~ 2004: ~~~ti~ ~~l'~u'~ c-~~~ ~.~.~'~% (SEAL) MAR MARGARET GUILLES SIGNED, SEALED, PUBLISHED AND DECLARED by the above-named MARY MARGARET GUILLES, Testatrix, as and for her Last Will and Testament in the presence of us who, at her request, in her presence and in the presence of each other, a(I being present at the same time, have hereunto set our hands as witnesses. `. - '`~ ~ ~=' (SEAL) `~~ ~ ~ -~ -~~ (SEAL) COMMONWEALTH OF PENNSYLVANIA ; :SS: COUNTY OF D~1tl-Pf~(N `{~,r E~ ; I, MARY MARGARET GUILLES, Testatrix whose name is signed to the attached or foregoing instrument, having been duly qualified according to law, do hereby acknowledge that I signed and executed the instrument as my Last WiII and Testament; that I signed it willingly; and that I signed it as my free and voluntary act for the purposes therein expressed. Sworn to and subscribed before me this ~ day of OC ~/,~~Ir , 2004. ~~~-L ~'~ NOTARIAL SELL (SEAL) Notary Public ~Ith~H171,No My Commission Expires: ~~~~ Raiivirw I1vp., Yor); Caunt~ -- ~ Cnmmiee+rtn ~~ NOC ~. ~ _ COMMONWEALTH -OF PENNSYLVANIA : :SS: COUNTY OF DA~f'~H~h~- ~O r- ~~ WE, ,~'1~~, I C (i`~ IT - ~~~ ~ ~ f~ l/' ~F- ~~~ ~ ~ 1'}'? u v>~ 1~~ c`. the witness s whose names are signed to the attached or foregoing instrument, being duly qualified according to law, do depose anc: say that `ire were presenf and saw MARY MARGARET GUILLES, Testatrix, sign and execute the instrument as her Last Will and Testament; that she signed willingly and that she executed it as her free and voluntary act for the purposes therein expressed; that each of us in the hearing and sight of the Testatrix signed the Will as witness, and that to the best of our knowledge, the Testatrix was at that time 18 or mare years of age, of sound mind and under no constraint or undue influence. Sworn to and subscribed before me this ~ day of ~ ~,,~.~ (~ ~ , 2004. Notary Public My Commission Expires: (SEAL) MARY MARGAR T GUILLES NOTARIAL SEAL Cnndith Y. Hill, Notary Pt1hliC Pairview'I~_ York County Estate of: Mary M. Guilles D.O.D. 11-23-2009 File No. 21-09-1153 ATTACHMENTS TO: Pennsylvania Inheritance Tax Return Form REV-1503 Schedule B Stocks & Bonds CC?~iE: Historical Prices for CNB Financial Corporation -Yahoo! Finance Page 1 of 3 New User? Sign Up Sign In Help Make Y! My Homepage Yahoo! Mail ~,~~~~~~ ~~ ~14 ~ ~ Search - _____..-_________.__ Web Search ~__.. _ _ Dow ~ 0.00% Nasdaq ~ 0.38% Wednesday, January 27, 2010, 2:56PM ET - U.S. Markets close in 1 hour and 4 minutes. GET GUDtES Finance Search CNB Financial Corp. (CCNE) ~//~6~A y G,S~ "~~""~`"""`^~'~°°°°°°°°~-~ ~ At 1:45PM ET: 1S.US •0.27 (1.83%) Tien M.r.- .+-..... ~~~ ~ . j! ' 1 ~__.__. _~._.__.~..._a ~' ~~~ ~t~o~Es t:i t :ecs sccurmer l ~[ •' xsi istorical Prices SET DATE RANGE Get Historical Prices for: ~~ G~ • Daily Start Date: Nov ~ 23 2009. E9• Jan 1, zoo3 • Weekly End Date: Nov 23 2009 • Monthl ~~~- Y • Dividends Only Get Prices First ~ Prev ~ Next ~ Last PRICES Date Open High Low Close Volume Adj Close` 23-Nov-09 16.58 17.36 16.58 17.31 5, 300 17.14 Close price adjusted for dividends and splits. First ~ Prev ~ Next ~ Last fi Download To Spreadsheet /~ r / ~f/~. D f /~/~,~f ~, //d ~~ ~~v~~~~c~s ADVERTISEMENT 0 U « ~} (j ~: 4 t'j 1 • ~ ~ 1 is . ~ '~ ~/ ~~ ~~~ U J .~'J •~ • ;~ 1 -;- ~,/ y t~~~~J + d dl G~7~~ ~vc~ r i~ ~ ~ • ~ j -~ http://finance.yahoo.com/q/hp?s=CCNE&a=10&b=23&c=2009&d=10&e=23&f=2009&g=d 1/27/2010 FINANCIAL CORPORATION September 15, 2009 CNB Shareholders: The Board of Directors of CNB Financial Corporation is pleased to present to you the third quarterly dividend for 2009 of $0.165 per share to shareholders of August 31, 2009 record date. if you have any questions concerning this dividend, our transfer agent, Registrar and Transfer Company, is available to assist you. You can reach Registrar and Transfer Company: By Phone: By Mail: 1-800-368-5948 Registrar and Transfer Company On the Web: 10 Commerce Drive www.rtco.com/inv Cranford, New Jersey 07016-3572 C~N~/B/JFQinancial Corporation V" tX.GI~-. ~. William F. Falger President and CEO FINANCIAL CI7RPCI~ATIDN ADDRESS CORRECTION CARD - DO NOT MAIL IF INFORMATION IS CORRECT AS SHOWN. FOR YOUR CONVENIENCE, THIS FORM SHOULD BE USED FOR REPORTING A CORRECTION OF YOUR ADDRESS WHICH NOW APPEARS IN OUR RECORDS AS SHOWN BELOW OR VISIT RTCO.COM TO EFFECT THIS CHANGE. MARY M GUILLES 212 MESSIAH CIR MECHANICSBURG PA 17055 RECORD DATE: 08/31/2009 PAYABLE DATE: 09/15/2009 DIVIDEND PER SHARE: .1650000000 NUMBER OF SHARES: 420.0000 /~pC/ PAYMENT INFORMATION l~ $69.30 :GROSS AMOUNT $207.90 :YEAR TO DATE LESS WITHHOLDING OF $.00 :FEDERAL TAXES $.00 :YEAR TO DATE :OTHER TAXES :YEAR TO DATE $69.30 :NET AMOUNT REQUEST FOR CHANGE OF ADDRESS (SEE REVERSE SIDE) ACCOUNT NO: 0017850002 Keep this stub - A 1099 Dividend will be provided at year end. 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Sign U(p~, Sign In Help Make Y! My Homepage Yahoo! Mail ~~~~ ~^'~ ~~ ~ ~ ~ ~ ~ ~ ~ Search ___.________.____~ ._____r_____, ~~ Web Search DOW '+ 0.16% Nasdaq '~' 0.50% Wed, Jan 27, ' 010, 3:30PM ET - U.S. Markets close in 30mins 1 __ .r.....w GET ~U~@iTES Finance Search FirstEnergy Corp. (FE) ~/'ti/ yS~ } At 3:15PM ET: 43.$$ *~ 0.73 (1.64%~ ,~ ~ ~ ~+ ..,. ~r8i~e IVl~W i- R r' ~~~ ~/~~~ , : t 5 14e1a l~- _... .__ __ •w.o fkTRRPE ScCnrfYlct LLC ~ ~ ~w~~ "` istorical Prices Get Historical Prices for: ~~ GO SET DATE RANGE • Daily Start Date: Nov ~ 23 2009.. 2oo3an 1, • Weekly End Date: Nov -~ 23 2009 • Monthl r-..~ ~- ~~- v • Dividends Only Get Prices First ~ Prev ~ Next ~ Last PRICES Date Open High Low 23-Nov-09 Close Volume Adj Close' 42.11 42.64 41.95 42.11 2,836,200 42.11 `Close price adjusted for dividends and splits. First ~ Prev ~ Next ~ Last ri_Download To Spreadsheet ode , ~ ~ ~~a` ~ + ~i ~ ~ ~ ~~, ~~ y ADVERTISEMENT http://finance.yahoo.com/q/hp?s=FE&a=10&b=23&c=2009&d=10&e=23&f=2009&g=d 1/27/2010 Detach Here Detach Here \~ .9mer-ican Stock Ti-ansJer INFORMATION STUB OPERATIONS CENTER ~ & Trust Company, LLC 6201 15TH AVENUE ~~(~G~ G' S ' ~' ~ BROOKLYN, NY 11219 Telephone: 800-736-3402 Option (1) Web: www.amstock.com Record Date Payable Date 08/07/2009 09/01/2009 Record Date Dividend Rate ertificated Shares P 564.0000 0.5500000 ~-i Record Date Account Number Book Shares o.oooo 0000625504 Record Date Plan Shares Net Dividend Reinvested 0.0000 0.00 Dividend Reinvestment Option Net Dividend Paid 310.20 CURRENT DISTRIBUTION YEAR-TO-DATE Gross Dividend Gross Dividend 310.20 930.60 Taxes Withheld Taxes Withheld o.oo o.oo Net Dividend Amount 310.20 Check Amount Check Number 310.20 301436072 11A A f'1\/ A A /~i lil i ...., ,r, uv1~LLJ 15236 Z1 OC U G 0 rn ~Y ~ U o° v cn ~~> LLaZ W Y H LL ~¢ z O v ¢ 3 m ~ w z ~"_'z x w A. 0 V W ~/ .~ 1~1 LL O O ~_ o a o 0 ¢=W a ~ w cn O o w U Z ? ~ F- .~ ~ ~.,¢ w '~ ~ W ~ Q, ~ m < r ¢ (7 Z ~ N ~ o~¢ ~~.. ,. ~ U Z Z ~ ~Qa~ N O ru `~' ~' ..d. ~ H O _ ~ C l9 ~ W ~ ~ ¢~ ~ ~ ~' d W ~ V ~ z N Q ~ ~ ~ ~{i m ~~. ~. ~ ~ 3 Q } ~~~~_ ~ ~.~ ~~ N \, U ~ ~j1 Q a Z 0 - i` `. ~ o ~~ ~ W ~~~`~~~ ~ \ d \ ~ ~ ~ (n ~ t` . , l ~~ ~` W a ~ .:1 J ~;,~ `~ ~ ~ Q .~ ~ - o ~ '~ ~ ~~ = o ~~, ~~ ~s ~ ~ - z LL z~ ~ ,~ 5 `\ N U Q ~\- ~ 2 ti. 2 ~ ~ ,~ ~ W X ~\ \ ~_... d t~ ~ a LL (~ ~~\ Q J ~ .~ -~v` W L ~ _ ~ J .~~` ~C ~~~~ ()` H ~ \ ~ ~~~~\J ~ %~ Y h `3- ~." ~~...~~ '''i,. v iK~~ ~~~ Y ~vM in~~^'_~~~.+~ '~ ~ F ~~~ tdu4+R~*.'~~"'~rS ~f'''~1i ~1~ S ~'' .tr'=r~=3+ 1 ~~.-,."'~`k-%:: 7~~ ~l v ~ "i, ~.-', +.,~ , 7° ~'""` ?~'i.,.-V~.t '~ F_i-~ - ,~ ~ '~,~ lt,~, p .+., _ .e + `'i4' s i+. 9•t . - , Y~,3 i '. ~- ~? .. f:. ~,,..;~=,:a:.. ~ ~, ~) t ~i ~~ t?'~ta '~~',E~ ', L ~~'! If~ ~Ny~-~~+~ 7~Yt ~~ 1,~ i ?~ '~~ Ft1'~'~ ~~ ~~-`# 'Er ~'` ~~ '~:-.- r +~' ~ V"j' ~rr '~j. ~ ~~+ r~ ~ .«.~ a ~vef ~~i t {~` .-xk"•'+~'`~!;4t~':rd ~ p ~#``~}1 ~' I; ,s ~ .~ ~Y: L- dt~ wk+ 7u:.. 7 ~ . + s .r ~ Jy ~ t 't"';~ ,;3;, uA 1 4 i t W 'j4 ~ i,. Ir .+ _~7t . ~;~ -,~; ,~ ~ ,~_ MTL P QQ. K: Historical Prices for MOTORS LIQUIDATION -Yahoo! Finance Page 1 of 3 Ne~w~U'ser? Sign Up Sign In .Help Make Y! My Homepage Yahoo! Mail 1~~~~~ ~~N~~~~ Search Web Search DOW ~" 0.41% Nasdaq '* 0.80% Wed, Jan 27, 2010, 4;43PM ET - U.S. Markets closed ~~t!!rs'rES Finance Search Motors Liquidation Company (MTLQQ.PK) ~O`r"C At 3:59PM ET: 0.66 f' 0.0090 (1.38%) ~~ 11~! Y~'8dE NOW l,. EXTRRPE Sc[urlt {ct LI,C ,, _ 4.~r,v.,,-.,..,v __ x. istorical Prices SET DATE RANGE Get Historical Prices for: ~~ GO • Daily Start Date: Nov 23 2009 Eg. ]an 1, _. -_- _ -_..._ „-; zoo3 • Weekly End Date: Nov - 23 2009 • Monthly ~~~ ~~~ ~~~ ~ ~ • Dividends Only 'Get Prices First ~ Prev ~ Next ~ Last PRICES Date Open High Low Close Volume 23-Nov-09 Adj Close' 0.66 0.70 0.63 0.67 1,987,200 0.67 " Close price adjusted for dividends and splits. First ~ Prev ~ Next ~ Last ri Download To Spreadsheet ~Ye . ~ ~/~y ~ ~ ~ ~ ~ 7 _. ~ Y ADVERTISEMENT http://finance.yahoo.com/q/hp?s=MTLQQ.PK&a=10&b=23&c=2009&d=10&e=23&f==2009&g=d 1/27/2010 MTLQQ.PK: 0.66 +0.0090 (+1.38%) :MOTORS LIQUIDATION -Yahoo! Finance Page l of 3 New User? Sign Up Sign In Help Make Y! My Homepage 'Yahoo! Mail - ~ ~ ~ l~t '~ ~~ ~-. __-___-_-___-_.-~. ~~~~_"~ Search Web Search P Dow 10.41% Nasdaq • 0.80% streamin g quotes: ON HOME INVESTING NEWS 8~ OPINION PERSONAL FINANCE MY PORTFOLIOS TECH TICKER Get Quotes I Finance Search Wed, Jan 27, 2010, 4:48PM ET - U.S. Markets closed ~~~ f settings Motors Liquidation Company (MTLQQ.PK) 3:59pm ET: 0.66 t o.ooso (1.38%) More On MTLQQ.PK Quotes Summary Real-Time Options Historical Prices Charts Interactive Basic Chart Basic Tech. Analysis News & Info Headlines Financial Blogs Company Events Message Board Company Profile Key Statistics SEC Filings Competitors Industry Components Analyst Coverage Analyst Opinion Analyst Estimates Research Reports Star Analysts Ownership Major Holders Insider Transactions Insider Roster Financials Income Statement Balance Sheet Cash Flow '~ . Ut~,l~'cta~,~e ~tuielancc E EoWT~gD6 SECVRITfE~ LLC Tlrade INow ,~ f..E li Rte. MOTORS LIQUIDATION (Other OTC: MTLQQ.PK) ___ _.. Last Trade: 0.66 Trade Time: 3:59pm ET Change: • 0.0090 (1.38%) Prev Close: 0.65 Open: 0.65 Bid: __ N/A Ask: N/A 1y Target Est: N/A Day's Range: 0.65 - 0.6690 52wk Range: 0.06 - 3.94 Volume: 2,153,006 Avg Vol (3m): 5,500,510 Market Cap: 402.97M EPS (ttm): .. __. -56.85 Div & Yield: N/A (N/A) Quotes delayed, except where indicated otherwise. For consolidated real-time quotes (incl. pre/post market data), sign up for a free trial of Real-time Quotes. Headlines Filter Headlines • Toyota US sales halt deals blow to image, earnings AP (Wed 3:55pm) ~GM offers incentives to lure fearful Toyota owners AP (Wed 3:34pm) • Spyker faces mountain to climb after Saab takeover AP (Wed 10:53am) • Tiger's absence from PGA tour starting to be felt AP (Wed 10:13am) China shares fall on worries stimulus ~~~~ MTLQQ.PK 27-Jan 3:59pm tC)Yahoo! 0.670 0.665 0.660 0.655 I ~,-ti~l~~~,~ 0.650 ---- '1~--------~ 0.645 10am 12pm 2pm 4pm 1d 5d 3m 6m 1y 2y 5y max customize chart Add MTLQQ.PK to Your Portfolio Set Alert for MTLQQ.PK Download Data Updates on your phone Add Quotes to Your Web Site http://finance.yahoo.com/q?s=MTLQQ.PK 1/27/2010 AnVFRTISFnnFnIT _ ~omputershare ~' 013 0 3 0 Computershare i. 250 Royall Street t~ Canton Massachusetts 02021 Within the US, Canada & Puerto Rico 800 331 9922 ,,,,,,,,,,,,, „ _ Outside the US, Canada & Puerto Rico 781 575 3990 AUTO 3 DIGIT 170 0000000381000013030 www.computershare.com/gm MARY M GUILLES 807 ROSEMONT AVE NEW CUMBERLAND PA 17070-2054 I~1~111~~11111~11~~111111„llllllll~ll~llll~~llll~~l~~lll~~lll Holder Account Number 00008386986 I N D Record Date 15 Feb 2008 Check Number 0000145703 SSNfTIN Certified Yes 001 CSOOOS.DOMEQS_PG I.GMC.14834_13106/013030/0 ] 3030/i6 General ~Ulotors~Corporation -Dividend P,ayrn>~nt ~ TM.~ ,~ , Dividend Confirmation Payment Date I Class Description I Participating I Dividend I Gross I Deduction Deduction Net ShareslUnits Rate Dividend ($) I Amount ($) Type Dividend ($) 10 Mar 2008 COMMON 100 $0.25000 25.00 0.00 NIA Year-To-Date Pafd 25.00 0 00 25.00 . 25.00 ^ 1UDC G M C '~" 002CD70002 OOHXDA PLEASE CASWDEPOSITTHIS CHECK PROMPTLY. f d ~~,~~ ..~ 'F N~ ~~ ~ ~~ ~~' ~,~ w ~u~ r~'R1 i ~ q! . ~ !iM ~H~ I ,. i ~# ,:I I ~~,. i~ AU..iiii.l VIII ~~W ,4: q fW4',~, 4 I ~I4~N ~. (, A ~A ' ~.~ ~, _, e o ', +`°~. n, I ~ ni n. ~ ~ ~r wr,yy,,,l~^~ ya'~~~.e ~`~ ~ ~~ ~~ i ~ ~ ~~ ~ ~ I Y ~~~ N ~' II 34~ ~ [ q~ I ~ / ~ c~i ` l11 s ~ . rl~~ :fit; ~ N` > `~ IA I~- ~, ~. --':_ EquiServe~ Trust Company, N.A. TRANSFER AGENT 6Y ~~ / ~~?ND REGISTRAR J AUTHORIZED SIGNATURE 1 ~~ ~ `~ a ~~ ~ , ~ ~ > ~ ~ \~ ~ ~ ~ o v, ~ \\~'~~ x. . ~ .~ ~+ ~ LL . ~ «. ~, ~ ~: ... a 7 ~~ ~ ~ ,~~~~ o ~ ~~~ ~ ~ ~ ~,-, ~~'~~ , .~ ~ S o: y ~ ~ ~ ~ ~" ~ ~ ~ ~ ~ ~ c~j ~' w ` ~ ~ C' cY Q ~ •~ .~ ~ '~' ~ \ \' ^~ w yl ~ .~ ~~ N (~d -. Tom. (,j) \ ~ ~\~ ^\\TT\~~'' Nj L'/"i N 1/~y~ Q ~l \~ ~V ~ ~y ~ ~U~ C: Z ~, U ~~.. ; ~,,., ~ y ~ w a ~i \ \'v~ v ^~ ~' ~_ v ~ ~ '~ ~ ~ a, ~ o ~'' ~` _~ ~ ~ ~ ~ > } ~ v \, `u V ~ w . LT ~ ~ ~ ~ v 5 ar-~ ~ - \, ~ ~ ~ ~ ~ \ L ~;i C9 ~' ~ ~ ~ ~i~` ~ ~ ~ ~~~~ ti ~v ~ ~ ~ ~ ~ ~~~~~ ~ = y y z w r O W W ~ Z U Z w o w y LL O ~:hr~ HAL: Historical Prices for HALLIBURTON CO -Yahoo! Finance Page 1 of 3 New User? Sign U~p*+~Sign In ,Help Make Y! My Homepage Yahoo! Mail 1~',~~3C~C~~'~ ~ ~ ~,p; ~'~] ~^ ~ Search `'~''`~ f _ _ , _ __ _.________~ ____., ---.........! € Web Search Dow T" 0.41% Nasdaq '* 0.80% Wed, Jan 27, 2010, 7:35PM ET - U.S. Markets closed _ Ggr ~~~ Finance Search Halliburton Company (HAL) ~/V,S~'~ ~" -~-~~-~--~--~.~ - At 4:O1PM ET: 3~.4~ ,I<. 0.47 (1.52°/a) Trade [~lo+~v "' ..~. '16~n hrw- ° LiA Al~ll~ ~ ~ y ~~~~~~~~~~~~~ 1z'6F.GE SCCUPIi{Cf LLC istorical Prices Get Historical Prices for: ~~ GG SET DATE RANGE Start Date: Nov - 23 .2009 • Daily Eg. Jan 1, 2003 • Weekly End Date: Nov 23 ii 2009 • Monthly • Dividends Only Get Prices First ~ Prev ~ Next ~ Last PRICES Date Open High Low Close Volume Adj Close" 23-Nov-09 30.63 30.89 30.21 30.44 11,344,300 30.35 Close price adjusted for dividends and splits. First ~ Prev ~ Next ~ Last Download To Spreadsheet ~ ~' ~~, .~ ADVERTISEMENT http://finance.yahoo.com/q/hp?s=HAL&a=10&b=23&c=2009&d=10&e=23&f=2009&g=d 1/27/2010 _o ~ 4. ~U rl O ~^ z o LL W W ~'- L ~ W ^ ~ LL Z °1 \ ~ U Z fU a ~ ~a W J b o S Ow \ L WH w= a w w V, W ~ f/1 ~ ~ ~ V w w = F ¢~ Wa 03 z a ,W WY m¢ ¢a W~ W ^o U ZW ~. a ^ a~ 4 a Q w O ~ ¢p m¢ WO a m O zF fV q ~ J a ~ Z UQ LLZ ~¢ w ~o ~ d z O Y U 0 F- L ` O ~ W \~ W a W ~~ m Q ~ ~~ w ~~ ~ e'~ N \ Q Z O Z ~0 h Z ~ ~\ ~ _c ~ ~~~ L \` J ~~ ~~\l L ~'1~Q ~~J ;, ~~ ~~~~ \\ r ~ ~ \~ ., •c /` ~. , C ~~ O Q a ~ ` ~ d m ~ N N U `° J ~ o J (~ Q V Q U °~' C ~.~ W N O ~w ~z N_ O)Z N O J ~ J ~ W d ~ c o~ d 0 U m ~ `~\~ (¢j O N m ~" a ~ _ z LL a o z In a 2 U U j y# ~ ~F #yyF N ~ ~ ~ T A A 001?534062161000ILLES--MARYM0000 6100 THE CHECK BELOW REPRESENTS A DI!/IDEND PAYMENT To make inquiries or enroll your account, contact BNY Mellon Shareowner Services HALLIBURTON f ~ Toll Free Number 800-279-1227 ~~'~~~~~ ~`1~~ Outside the U S. (Collect) 201-680-6578 ~ ~ VV Hearing Impaired 800-231-5469 AUTHORIZATION FOR INVESTMENT PLAN PROGRAM To participate in the Companys BuyDIRECTSM, complete and sign the enrollment form and return it in the enclosed envelope, or you may go to www.bnymellon.com/shareowner/isd or call the toll free number above. This will authorize the Company to forward to the Administrator all or a portion of the dividends you receive on common stock to be invested to purchase additional shares of the Company's common stock. All investments are made subject to the Terms and Conditions of the Plan as set forth in the Companys BuyDIRECTsM brochure available online in Investor ServiceDirect® at www.bnymellon com/shareowneriisd. Please review the brochure before enrolling. This authorization and appointment are given with the understanding that you may terminate them at any time by so notifying the Administrator. Should you enroll and own 100 shares or greater, you may choose to invest all or part of the dividends paid on the Company's common stock. Investors who own less than 100 shares will have the dividends for all of their shares reinvested if they choose to participate. (Pleases check one below.) Reinvest the dividends on ALL shares. ^ Reinvest a PORTION of my dividends. (If you own less than 100 shares, all dividends wi!! be reinvested.) Please remit to me the dividends on shares. I understand that the dividends on my remaining shares, as well as all future shares that I acquire will be reinvested. MARY M GUILLFS 80; ROSEMOT AVENUE NtW Ci.iMcitRLHiviJ PH 17070-2u54 Signature(s) 6100 Date Al! joint owners must sign exactly as names appear above. 00175340621610GU:ILLES--MARYM0000 ------------------------------ ---------------------- ~G DETACH AND RETURN ABOVE FORM _ RETAIN FOR YOUR RECORDS I- IMPORTANT T;tti)( IRFFORA+IATIfflN b 1"F?AAISACTION'DETAIL SHAREHOLDER OF !TRANSACTION DESCRIPTION HALLIBURTON COMPANY I DIVIDEND I INVESTOR /D CUSIP ACCOUNT KEY i TYPE OF SECURITY RECORD DATE i PAYABLE DATE 124993006939 1 753 40621610 , GUILLFS--MARYM0000 I COMMON 09102/2009 09/22/2009 RATE PER SHARE Ejt FICATED SHARES ENTRY SHARE ' - S GROSS DIVIDEND US TAX WITHHELD FOREIGN TAX WITHHELD $0.0900000 4,000 * 4 000 0000 , . I $720.00 $0.00 I $0.00 CURRENT DIVIDEND TAX WITHHELD YTD EIGN TAX WITHHELD YTD i DIVIDEND PAID YiD TAX I I IDENTIFICATION NUMBER ~, Please detach and retain this $720.00 $O.OD I $D 00 i $2 160 00 ON FILE form for your records. PLEASE DETACH BELOW CHECK NUMBER: 76047473 ---------------------- ---------- H~LLlBURTO~! DRS Stock Distribution Statement ....:::....:..... .:. ... ...~ . . ~> . ..............~......... .....:..::::.::...:::.: ~>~i~..:. ~lE~.:::..:l~a>~~~<: au621 c> lu I249~3uc1~t~3<~ _ _ for-I Slock Snli( H AL O 1-U6-001 1 J4 I MAIM' M GUIL.LGS R07 RUSFiMO'I' AVENUE MW CUMBERI.ND PA 17070-204 t~tlli~~~llitt,It~~IIL~~~tl~lllttttl~lttl~~llitt~l~~~ll~~~ Record Dote Shores c~rcir:;.a~ sh;a,;z: a.o~~o.oooo Book-Entry Shares: U.000U Total Record Date Shares: 4.000.oUUO Plus Distribution Additional Book-Entry Shm'es X1,000.000(1 li yunls Distribution Dttte Sh•tres Ccrliticata Shares: 4,OOU.QQnn Book-Entry Shares: 4,000.U00U Total Distribution Date Shores: g 000 0000 PLEASE RETAIN THIS STATEMENT FOR YOUR RECORDS This statement represents the shares of Halliburton Company ('`Halliburton") common stock that you held on the June 23, 2006 record date and the additional shares issued to you as a result of the 2-for-1 Stock: Split. The additional shares have been issued to you in book-entn- form as part of the Direct Registration S~~stem. Under this form of ownership, shares are recorded in your name on the books of Halliburton held by Mellon Investor Services, Halliburton's stock transfer agent and registrar. - NO ACTION IS REQUIRED if you choose to keep shares in book-entn~ form. uestions? Contact Mellon Investor Services To access your account, use your Investor ID Number that is located in the box above on the top right hand corner of this statement. You can contact Mellon Investor Services by one of the following ways: I3t~ Intertret: Visit www.melloninvestor.com/isd for access to youur account. You will be able to certify your Taxpayer Identification Number/Social Security Number, change your address, sell shares or request a certificate. I3r Phone Toll Free Number 1-800-279-1227 Outside the U.S. (Collect) 1-201-680-678 Hearing Impaired 1-800-231-469 IVR system available 24 hours/7 days a week Representatives are available 9 a.m. to 7 p.m. Eastern Time weekdays 131 Muil: Halliburton Company c/o Mellon Investor Services P.O. Box 3338 South Hackensack, NJ 07606-1938 IAR: 0.16 0.00 (0.00/0) ;IDEARC INC -Yahoo! Finance ,Q lJCtn~U f - ~ 4~~P Page 1 of 3 ~ 3~3~ v 9 New User? Sig~n-+Up .Sign In ;Help Make Y! My Homepage 'Yahoo! Mail ~~~~'"'~~~~ F ~ ~'~ N ~ E Search Web Search Dow t 0.41% Nasdaq t 0.80% streaming quotes: ON HOME INVESTING NEWS 8 OPINION PERSONAL FINANCE MY PORTFOLIOS TECH TICKER ................ i_ ot~~ Finance Search Wed, Jan 2'7, 2010, 8:14PM ET - U.S. Markets closed IDEARC INC (IAR) More On IAR Quotes Summary Real-Time Options Historical Prices Charts Interactive Basic Chart Basic Tech. Analysis News & Info Headlines Financial Blogs Company Events Message Board Company Profile Key Statistics SEC Filings Competitors Industry Components ~E 7R~ . ~aisnoc secunnef uG T~rl fr~`e f,r ,fr d.~,,.~ 1 IDEARC INC (NYSE: IAR) After Hours: 0.00 N/A (N/A) 7:OOpm ET Last Trade: x.16 Trade Time: Nov 17 Change: __ 0.00 (0.00%) Prev Close: 0.16 Open: _ _ N/A Bid: _ _ N/A Ask: ~~..~.. N/A 1 y Target Est: N/A ~ settings Nov 17: ~.16 0.00 (0.00%) TCad@ ~#lovv ~~ ', ~' ~~°~r ~~... :.F .die) ~. ~;,~Ma Day's Range: NIA - N/A 52wk Range: ....... . ... _...... _ N/A Volume: _ _ 0 Avg Vol (3m): N/A Market Cap: N/A .. .. P/E (ttm): ..... ..... . N/A EPS (ttm): N/A Div & Yield _. N/A (N/A) Quotes delayed, except where indicated otherwise. For consolidated real-time quotes (incl. pre/post market data), sign up for a free trial of Real-time Quotes. Analyst Coverage Headlines Filter Headlines Analyst Opinion • McClatchy Needs Mercy Analyst Estimates at Forbes.com (Wed, Jul 1) Research Reports Star Analysts » More Headlines for IAR Ownership Add IAR Headlines to My Yahoo! Major Holders Insider Transactions Insider Roster Financial Blogs Financials • No Financial Blogs available for IAR at thi Income Statement s time. Balance Sheet Cash Flow Reports http://finance.yahoo.com/q?s=iar Chart Not Available 1d 5d customize chart Add IAR to Your Portfolio Set Alert for IAR Download Data Updates on your phone ] Add Quotes to Your Web Site ADVERTISEMENT ~~. ~~~~ Join the ether elished husinesse.s 1~at have joined American Express C7PE1 ~ ~ • LfAiIN a!f0ltE s~+-"~'permec~~~ Idearc Completes Debt Restructuring; Emerges With New Name and Increased Client Focus Newly Issued Common Stock of SuperMedia Inc. Trading on NASDAQ Exchange Plan of Reorganization Effective as of December 31, 2009; Company Moves Forward with Restructured Balance Sheet and Debt Reduced to $2.75 Billion DALLAS, Jan 04, 2010 (BUSINESS WIRE) -- Idearc Inc. today announced that it has changed its name to SuperMedia Inc. (the "Company" or "SuperMedia"). The new name symbolizes SuperMedia's renewed focus on providing outstanding products including the SuperYellowPages(R), Superpages.com(R) and SuperpagesDirect(TM) direct mail products as well as services, such as the SuperGuarantee SM and SuperTradeExchange(R) Programs, to its clients and consumers nationwide. SuperMedia's shares trade on the NASDAQ Global Market under the symbol "SPMD" and the Company will take part in Opening Bell ceremonies on Wednesday, January 6, 2010. "This is an exciting day for SuperMedia, our teammates, our clients and all others who have supported us as we have taken action to strengthen our balance sheet and position the enterprise to succeed in a challenging and rapidly changing business environment," said Scott W. Klein, chief executive officer of SuperMedia Inc. "Our new name symbolizes the rebirth of our company and along with it the ability to continue to deliver innovative ways that will change the way in which we help match buyers with sellers," Klein added. "We will have much more to say about these initiatives -and our company's renewed sense of excitement and energy - in the days, weeks and months ahead." The name change follows the Company's emergence from a reorganization that reduced its total debt from more than $9 billion to $2.75 billion of secured bank debt. The Company's Plan of Reorganization (the "Plan") became effective on December 31, 2009. SuperMedia's equity capitalization will consist of 60 million shares of common stock and 5 million shares of preferred stock authorized for issuance. The terms, rights, and preferences of the preferred stock may be set from the Company's Board of Directors from time to time. Upon completion of all distributions to former creditors under the Plan, the Company will have approximately 15 million shares of common stock issued and outstanding. Paulson Standby Purchase Closina The Company also announced today that its standby purchase agreement with Paulson & Co. Inc. closed on December 31, 2009. New Board of Directors In conjunction with its emergence and in accordance with the Plan, the Company has a new Board of Directors. The newly appointed members are: Edward Bayone, the Earle W. Kazis Professor of the Practice of Finance and International Real Estate at Brandeis University's International School of Business. He previously held numerous positions at FleetBoston Financial Group, including Chief, Global Risk Management and Chief Credit Officer. Robert C. Blattberg, the Timothy W. McGuire Distinguished Service Professor of Marketing and the director of the Center for Marketing Technology and Information at Carnegie Mellon University's Tepper School of Business. From 1991-2008, he was a professor and director of the Center for Retail Management at Northwestern University's Kellogg Graduate School of Management. Charles B. Carden, former Senior Vice President and Chief Financial Officer for John li, Harland Company, a provider of products and services to the financial institution and education markets. He currently serves on the board of directors for Ivox Corporation, a privately held software company that provides driver-based risk ranagement information to fleets and insurance companies. Robin Domeniconi,Vice President, US Advertising for Microsoft Corporation. She has previously served as Senior Advisor/Media & Digital of Avista Capital Partners, President of Time, Inc. Media Group, and President and Publisher of Real Simple. Thomas Gardner, former Corporate Executive Vice President of Reader's Digest Association, Inc. He previously held numerous other positions with Reader's Digest. He has also served as a director for Northern Westchester Hospital, Reader's Digest Foundation, and the Williams College Society of Alumni Executive Committee. David E. Hawthorne, former President and Chief Executive Officer of Lodgian, Inc., an independent hotel owner and operator. Since 2005, he has been with Hawthorne Management LLC, a firm that develops, owns, and operates commercial real estate in central Florida. Scott W. Klein, Chief Executive Officer of SuperMedia Inc. He became CEO and a director of Idearc Inc. in June 2008. He previously served as an operating partner of Symphony Technology Group, a private investment firm, and as President and Chief Executive Officer of Information Resources, Inc., a provider of information solutions for the consumer packaged goods, retail, and healthcare industries. Prior to joining Information Resources, Mr. Klein served as President, Consumer Industries, Retail & Energy Global Industry Group of Electronic Data Systems Corporation. Thomas S. Rogers, President and Chief Executive Officer of TiVo Inc., where he also serves on the board of directors. He joined the Board of Idearc Inc, in December 2007. He has previously served as chairman of the board of Teleglobe International Holdings, Ltd., a provider of international voice, data, Internet, and mobile roaming services; chairman of Trget Media LLC, a media industry investment and operations advisory firm; chairman and chief executive officer of Primedia, Inc., a print, video, and online media company; and president of NBC Cable for the National Broadcast Company, Inc. Cancellation of Old Idearc Common Stock In accordance with the Plan, the pre-emergence common stock of Idearc Inc. (which has recently traded under the symbol "IDARO.PK ") was cancelled effective December 31, 2009. Holders of the old Idearc Inc. common stock will not receive any ~~ distributions as part of the Plan and their equity interests have no value. No further transfers of the old Idearc Inc. common stock will be recorded on the Company's books. Forward-Looking Statements Certain statements included in this press re/ease constitute forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Statements that include the words "believe, " "will, " "would, " 'propose, " "anticipate, " "foresee, "and similar expressions identify forward-looking statements.For a discussion of the risks and uncertainties see ldearc's periodic filings with the Securities and Exchange Commission, which you may view at www.sec.aov. and in particular, Idearc's Annual Report on Form >0-K for the fiscal year ending December 39, 2008 and Idearc's subsequent Quarterly Reports on Form 70-Q. About SuperMedia Inc. SuperMedia (NASDAQ;SPMD) is the advertising agency for local small to medium sized businesses across the United States. SuperMedia specializes in results. Click-here results. Ring-the-phone results. Knock-on-the-door results. SuperMedia's advertising products and services include: the SuoerGuaranteeSMavd SuoerTradeExchanae(R) programs, Verizon(R) SuperYellowPages, FairPoint(R) SuperYellowPages, Suoeroages com(R), EveryCarListed comsM Switchboard.comSM, LocalSearch.comSM, Suoeroaoes MobileSM and SuperpagesDirect(TM) direct mail products. For more information, visit www.suoermedia com. SPMD-G SOURCE: SuperMedia Inc. SuperMedia Inc. Media Relations: Andrew Shane, (972) 453-6473 andrew.shane~supermedia com or Investor Relations: Cliff Wilson, (972) 453-6186 cliff.wilson@supermedia com Copyright Business Wire 2010 ide~rc ""'"'"""'"""`AUTO"'3-DIGIT 170 ~ ~~ ~,omputershare 0 4 3 3 6 5 Computershare 250 Royall Street Canton Massachusetts 02021 Within the US, Canada fr Puerto Aico 800 756 8600 Outside the US, Canada 8 Puerto Aico 781 575 3995 000000119/000043365 www.computershare.com/idearc MARY M GUILLES 807 ROSEMONT AVE NEW CUMBERLAND PA 17070-2054 I~~~III~~~lll~~~l~~~lll~~~~rl~lll~r~~l~l~~lr~lll~~~l~~~ll~~~ll Holder Account Number 00004320476 I N D Record Date 21 Feb 2008 Check Number 000165'1802 SSN/TIN Certified Yes 001 CSOOOS.LIOMEQS_PG 1.IAR.1 A206__l 3 3 70/043 3 65/043 3 65/i6 Idearc Inc. -Dividend Payment Dividend Confirmation Payment Date Class Description I Participating I Dividend I Gross I Deduction Deduction Net Shares/Units Rate I Dividend ($) Amount ($) ~ Type Dividend ($) 13 Mar 2008 COMMON STOCK 26 $0.34250 g,91 0.00 N!A 8.91 Year-To-Date Paid 8.91 0.00 8.91 ^ 1UDC I A R -~- 002CD7CD0~ OOHXDA PLEASE CASH/DEPOSIT THIS CHECH PROMPTLY. ,TNJ: Historical Prices for JOHNSON AND JOHNS DC -Yahoo! Finance Page 1 of 3 New User? Sign U~rp-~Sign In !Help Make Y! My Homepage Yahoo! Mail ~~~~'"'~ ~~ ~ ~ ~"'+ ~ ~ ~ ~ Search ~~~ "`~ - _-----_________________________ Web Search Dow 't 0.41% Nasdaq ~ 0.80% Wed, )an 27, 2010, 9:16PM ET - U.S. Markets closed Gi~T aiKi}TE3 Finance Search Johnson & Johnson (JNJ) At 4:OOPM ET: 63.44 t o.s5 (1.04%) ~~ ,. , ~ ~ iq i,~ ~ it 1~111~iRlTRiliiA~l;~ ~'t'>~@ NOIIY' n~: ^ ~~ 11an h~- x :; _7kad$-~. IStOrIGa~ PriGeS SET DATE RANGE Get Historical Prices for ~~ GO • Daily Start Date: Nov ~ 23 2009 Eq. )an 1, 2003 • Weekly End Date: Nov ' 23 2009 • Monthly • Dividends Only G,_ et Prices First ~ Prev ~ Next ~ Last PRICES Date Open High Low Close Volume Adj Close' 23-Nov-09 62.49 63.10 62.42 62.69 13,868,100 62.69 "' Close price adjusted for dividends and splits. First ~ Prev ~ Next ~ Last r~i Download To Spreadsheet V ADVERTISEMENT littp://finance.yahoo.com/q/hp?s=JNJ&a=10&b=23&c=2009&d=10&e=23&2009&~;=d 1 /27/2010 JN,T: Historical Prices for ,TOHNSON AND JOHNS DC -Yahoo! Finance Page 1 of 3 New User? Sign Up 'Sign In Help Make Y! My Homepage Yahoo! Mail ~.~.~~'~~~ F~N~~G~ Search ~ WebSearch DOW • 0.41% Nasdaq '~ 0.80% Wed, ]an 27, 2010, 9:17PM ET - U.S. Markets closed 61:'r CiUK~TE~ Finance Search Johnson & Johnson (JNJ) <`~ySr~~ At 4:OOPM ET: 63.44 t o.s5 (1.04%) - ~ ~ ' E"i~~AC~ ~p,r~nr~ Trade Naw ,rA ti«.- ~. istorical Prices Get Historical Prices for: ~~ GO SET DATE RANGE Start Date: Jun - ~- ~- E ~ Daily 2009 ' 9• Jan 1 _... _ -- . _ ~ zoo3 • Weekly End Date: Dec ~~ 31 2009 i • Monthly • Dividends Only Get Prices First ~ Prev ~ Next ~ Last PRICES Date Open High Low Close Volume Adj Close" 20-Nov-09 $ 0.49 Dividend 21-Aug-09 $ 0.49 Dividend ' Close price adjusted for dividends and splits. First ~ Prev ~ Next ~ Last r~'1 Download To Spreadsheet ADVERTISEMENT http://finance.yahoo.com/q/hp?s=JNJ&a=05&b=1 &c=2009&d=11 &e=31 &f=2009&>?=v 1 /27/2010 c~,~ ~~~ i 4 !_` ~ or ~~ f '~ J III^~I~ r ~~ Iid- ~ -' i~_ ~P y ,' I ~ ~ li _ ~~ ~ I - I ~ `~~~~ ~~ i ~~ ~~~' \~ ~ ~~ ~" i~ I ~~~'T <if i ~` Ifi ..I~J,~~ ~~: !~f tw i ~ J Z ~ ~~ i rrlYflltll1 ~ F - r = i( 1 I ~~ T = ~ ~\ `ice - - _ ~ ~%(~%~I,~~i~~~~~"~~~~ = ~ t~ r+y" m ~ A ate` ~ - 000NTERSIGNEDANDREGISTERED: I~%Iidhir~~l~~~g ~`~' I ~~~ EQUISERVE TRUST COMPANY, N.A. ~~ - TRANSFER AGENT ~ ~~ f1~yl ~~ 1 T a-S BV AND REGISTRAR ~ i~}!A~o~iy~ry~~lV~ ~~ . _ ~ I ~.1~ tl 4 } i 1 +ll AUTHORIZED SIGNATURE ~ i ~~ ~ rn i~ .A ~ - I :I ~ l 11 ~ _' I V e`~i8 'rT01 t ~~II ~ .z 1, (j ~' ~ ~\ .l! -l_ ~ ~'~~ ~ ~ f` ~ - A ~ "'r~ ~; ~' ~III~ ~I g ~s, ~~~ ~ ~ ~ ~ ~I ~~ ~~~~ ~ a ' ' Y ~ ~ ~ I ( » ~ O ww N ~ ~ ~ s » ~' V' ~ a Yr S~ ~f ,v ~, j~/~ ~I y I ,:' O O ~~ U1 ~ ~ ~ N ~ ~ `~~(}}a~71 ~!~i7 x : •~, 11 - C1 °: I a 0 ~~ `' ~ f ' ~= ,fl ' ~ ~ ~ ,f ~~~ ~ ~ I _ ~~ ~ ~sAe. 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TF.RUL SCCUi{tlCf l~C..... ~..,,, istorical Prices Get Historical Prices for: G0 ~: SET DATE RANGE • Daily Start Date: Nov, - 23 2009, E9• Jan i, 2003 • Weekly End Date: Nov ~-- 23 2©09 ~ • Monthly ~__ _ • Dividends Only Get prices '` First ~ Prev ~ Next ~ Last PRICES Date Open High Low Close Volume Adj Close" 23-Nov-09 48.39 49.07 47.81 48.36 302,300 48.36 Close price adjusted for dividends and splits. 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Finance Page 1 of 3 New User? Sign Up Sign In .Help Make Y! My Homepage Yahoo! s~-~ Mail ~.~~~...+''~~~ F ~ ~ ~ ~ ~ F Search ~__.._.___-____ ~ ~____ _._. Web Search DOW "f' 0.41% Nasdaq ~ 0.80% Wed, ]an 27, 2010, 10:O1PM ET - U.S. Markets closed ~~~' Finance Search Verizon Communications Inc. (VZ) "°""°~'""""""`""""""^""^°~°~ ~-~ At 4;OOPM ET: 29.87 ~i 0.30 (0.99%) +llilT~ ~ Y~S~ f? N~oW .l ,.~ ~.,~.,-..,--•-~._..~._.._ _....._.»..a._~.~,,:. E!.:~A:.L S¢CUfViI¢f LLC ... ~ `~` istorical Prices SET DATE RANGE Get Historical Prices for; ~~ GO • Daily Start Date: Nov ~ 23 2009, E9• ]an 1, ~~ ~ - ~ ~ zoo3 • Weekly End Date: Nov ~- 23 201J9 • Monthl ~~~- Y • Dividends Only Get Prices First ~ Prev ~ Next ~ Last PRICES Date Open High Low Close Volume Adj Close" 23-Nov-09 30.75 31.40 30.57 31.33 22,037,100 30.88 " Close price adjusted for dividends and splits. 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Guilles D.O.D. 11-23-2009 File No. 21-09-1153 ATTACHMENTS TO: Pennsylvania Inheritance Tax Return Form REV-1508 Schedule E Cash, Bank Deposits & Miscellaneous Personal Property ~~ LfA~IN67~#E W41f January 20, 2 0 i 0 pNC BP,NK 4.12-7C5-2747 Vo. F285 P. 1~'1 PNCBANK Amanda Li 5288 Simpson Ferry Rd Mechanicsburg, PA 17050 RE: Name: Mary M Guilles SSN: 23x,42-9282 DOD: i1-23-2009 Isar Ms. Li: Amanda Li Financial Sales Consultant T 717-697-3015 F 717-795-6187 amanda.li@pnc.r_om Member of The PNC Financial Services Group 5288 Simpson Ferry Road Mechanicsburg Pennsylvania 17050 In response to your request for Date of Death (DaD) .balances for the customer z~ated above, awr recr~rds show the foIlowing: CheclrJung AGCOUnt Account # 5005059455 Established: 06-09-2009 MARX M GUILLE$ LOU ANN GUII,LES DOD balance: $151,231.89 + 11.11 acen2ed interest Interest paid 01-01-2009 thru 11-23-2009 $57.37 YTD Account # ~ 140025253 Established: 10-01-1960 MARY M GUILLES DOD balance; $6,201.00 nozt interest bearing Savings Aceount Account # 5004396121 Established: 02-042004 MARY M GUII.,LES DOD balance: ~27,921.9D + 10.46 accrued interest Interest paid O 1-0 ] -2009 t1u1,:11-23-2009 $138.5 ] Y :~J Please note that tlxis o£I'ice provides date of death balances for deposit accounts {IR.As, CDs, Checking and Savings). We do aot process any financial transactions or provide s~tements. If you need assistance with any of these items, please call 1-888-PNG-BANK (]-888-762-2265) or stop by your local PNC Hank branch af~ice. Sincerely, National Financial Services Center PNC Bank; N.A. . Member FDIC Page 1 of 1 January 12, 2010 PNC Bank External Confirmation 8800 Tinicum Blvd. Philadelphia, PA 19153-3198 RE: Estate of Mary Margaret Guilles Social Security #: 235-42-9282 Date of Death: November 23, 2009 To whom it may concern: I am the Executrix for the Estate of Mary Margaret Guilles who died on November 23, 2009. Attached please find a Letter of Testamentary and a Death Certificate. Please provide the following information with regard to the following accounts or any other accounts the Decedent held with PNC Bank, on or near the Date of Death of November 23, 2009: Account #51-4002-5253 Type: Reeular Checkins Open Date: )O~(~ ~ ~ (~Ip(7 In the name of: `MO~V ~\/\ ~ `fie Date of Death Ba ante: $ ~ l• CSC Interest paid (Year to Date) from 1/1/2009 to Accrued Interest as of Date of Death: $ Other Info. deemed relevant: 11/23/2009 = $ N F'~ (not included above) Account#50-0439-6121 Type: Premium Money Market Open Date: 2'~-~ f 200 In the name of: YV\('~y'\I ~ 1 ~~,~ ~ Date of Death Balance: $ _ ~ ~ Q21 . ~ ~ Interest paid (Year to Date) from 1/1/2009 to 11/23/2009 = $ 13~ ,~_ Accrued Interest as of Date of Death: $ I O - \O (not included above) Other Info. deemed relevant: Account#50-0505-9485 Type: Performance Checkin Open Date:~~ Z-00~ In the name of: LpU ~V1 (-91~~~(p~ Date of Death Balance: $ 151 Z.J ~ 8~ Interest paid (Year to Date) from 1/1/2009 to 11/23/2009 = $ 51 ~ :•~ Accrued Interest as of Date of Death: $ 1 ~ - 1 ~ (not included above) Other Info. deemed relevant: I have provided partial information with regard to the three accounts of which I am aware. Please complete the additional information requested above for these three accounts„ PNC Bank Estate of Mary Margaret Guilles January 12, 2010 Page 2 In addition, please provide the same information for any other accounts you identify in which the Decedent had an interest. Please respond directly to the accountant for the Estate, Richard H. Flowers, II, CPA, at 5775 Allentown Blvd. Suite 102, Harrisburg, PA 17112. If you have any questions, please contact Mr. Flowers at (717)652-6564. Thank you for your prompt assistance. Sincerely, ~~~)~ Lou Ann Guilles Executrix Attachments (2) (Financial Institution Authorized Signature) Title: _~1V1~ .10.~ Scj.~Q.S LO~Sv~~-~- Date: ~ ~ 2 ~ ~ 2.0\~ rho tat Banking St~.tement ' PN C BANK PNC L'anl: Primary account number: 51-4002-5253 For the period 10/30/2009 to 17/27/2009 Page 1 of 2 Number of enclosures: 0 v MARY M GUILLES D For24-Ilottr banking, and transaction or 212 MESSIAH CIR ~ interest rate information, sign onto MECHANICSBURG PA 17055-8619 PNC Bank Online Banking at pnc.com. 'a For customer service call 1-888-PNC-BANK Monday -Friday: 7 AM - 10 PM ET Saturday & Sunday: 8 AM - 5 PM ET Para servicio en espan'ol, 1-866-HOLA-PNC MovingT Please contact tts at 1-888-PNC-BANK ® Write to: Customer Service I'O Box 609 Pittsburgh PA 15230-9738 ~/isit us at pnacom TDD terminal: 1-800-531-1648 For hearing unpaired clients only Relationship Ovelrview Bank Deposit Accounts Description Account Number Re lar Checkin r Deposit Balance ~ ~` ~ 1-4002-52Ci3 Premium Money Market 50-0439-6121 6,105.00 Total Deposits 27,933.89 34,038.89 Your everyday banking and purchases just got more rewarding with PNC points(sm). Use your PNC Visas Check Card and points Visa credit cards`. Earn points. Pay a bill online. Earn points. Elect to receive your checking account statement online. Earn points. Enroll today at pnc.com/points or call 1-888-PNC-points. See how quickly you earn rewards! And, the best part...it's free! "Subject to credit approval. Note: PNC Bank Select Rewards Visa Platinum, Visa Signature Rewards, and Visa Platinum Credit Cards are not eligible for enrollment in the PNC points program at this time. The new points Visas credit cards will be available to customers 11/9/09. PNC points is a service mark of The PNC Financial Services Group, Inc. PNC Bank reserves the right to change or terminate the PNC points program. See Terms and Conditions for complete details. ~~~,~!ali' ~r~~c8r119-~'i ~ccoaln~Y .~selniina®"~ Mary M Gurlies Account ntltnber: 51-4002-5253 Overdraft Protection Provided By: XXXXXX6121 Balance Summary Beginning Deposits and Checks and other b Ending alance other additions deductions balance 3,861.69 2,928.14 684.83 6,105.00 Average monthly Charges balance and tees 6,154.14 .00 Transaction Summary Checks paid/ Check Card POS Check Card/Bankcard withdrawals signed transactions POS PIN transactions 9 0 0 Total ATM PNC Bank Ofher Bank transactions ATM transactions ATIv1 transactions 0 0 0 FORM953R-1005 Total Banking Statement For 24-hour information, sign on to PNC Bank Online Banking IFor the period 10/30/2009 to'11/27/1~009 on pnc.com. MARY M GUILLES Primary account number: 51-4002-5253 Account number: 51-40(12-5253 -continued Page 2 of 2 Activity Detail Deposits and Other Additions Date Amount Descrlptlon 10/30 1,499.14 Direct Deposit -Annuitant PA Treasury Dept XXXXXXXXXXX9826 1 1,/03 1,429.00 Direct Deposit - Soc Sec US Treasury 303 XXXXX9282A Checks and Substitute 'Checks Check Date number Amount paid 1544 128.00 10/30 1Ci46 * 58.99 11/03 1547 101.55 11/05 1548 52.99 11/09 I~riO ~~ 175.00 11/10 * Gap in check sequence There were 2 Deposits and Otlier Additions totaling $2,928.74. Reference Check number number Amount Date paid Reference 083198252 1551 16.00 11/ 17 number 086081 084201993 1552 13.43 11/lfi 939 085587 520715775 1553 29.71 11/ 16 294 5205 0 086721364 15,54 96 00 11/27 1 (137 [1218659997 . 086146805 Online .and :Electronic Banking Deductions Date Amount Descrlptlon 11/09 13.16 Payrnent,E-Check Util Pmt UGI Utilities 1549 -Daily $alance -Detail Date Balance 10/30 5,232.83 11/03 6,602.84 Date Balance 11/05 6,501.29 11/09 6,435.14 There were 9 checks listed totaling $671.67. There was 1 Online or Electronic Banking Deduction totaling $13:16. Date Balana> Date / 11/10 6,260.1~i; Balance ~/ 11/1G 6,217.00 11,/17 6,201.00 11/27 6,105.00 Premium Money Market Account Summary Mary M Guilles Account number: 50-0439-6121 Overdraft Protection Provided By: Contact PNC .to establish Overdraft Protection Balance Summary Beginning Deposits and Checks and other Ending balance other additions deductions balance 27,921.90 11.99 .00 27,933.89 Average monthly Charges balance and fees 27,922.31 .00 Interest Summary As of 11/27, a total of $156.50 in interest Annual Percentage Number of days Average collected Interest Paid was paid this year. Yield Earned (APYE) in interest period balance for APYE this period 0.54% 29 27,922.31 11.99 Activity Detail Deposits and Other Additions Date Amount Description 11/27 11.99 Interest Payment Daily Balance Detail Date Balance / Date 10/30 27,921.90 ,~// 11/27 Balance 27,933.89 There was 1 Deposit or Other Addition totaling $11.99. January 12, 2010 Susquehanna Valley FCU 3850 Hartzdale Drive Camp Hill, PA 17011-7809 RE: Estate of Mary Margaret Guilles Social Security #: 235-42-9282 Date of Death: November 23, 2009 Member # 55 To whom it may concern: I am the Executrix for the Estate of Mary Margaret Guilles who died on November 23, 2009. Attached please find a Letter of Testamentary and a Death Certificate. Please provide the following information with regard to the following accounts or any other accounts the Decedent held with PNC Bank, on or near the Date of Death of November 23, 2009: Account #00 Type: Regular Shares Open Date:~_7 ~~'/ ~',j In the name of: /" ~[,/ //~ Date of Death Bal ce: $ - , 07~ ~ a25 Interest paid (Year to Date) from 1/1/2009 to 11/23/2009 = $ Accrued Interest as of Date of Death: $ (not included above) H c ~ (- Other Info. deemed relevant: f/1~ii, yvCt.1 i~l{~~-~S¢ :~T ~~ ~ ~ S ~~-'/O ~lCCry Chose ale ~~n ~ltr,~J ~- r f!7 P Li' ~' Account #10 Type: Life Savings Insurance Shares Open Date: In the name of: /G,, ~(/ ~~ Date of Death B ance: $ ) --~ Interest paid (Year to Date) from 1/1/2009 to 1123/2009 = $ Accrued Interest as of Date of Death: $ ~+ ~ 3 (not included above) Other Info. deemed relevant: Account #55-5568 Type: 5 Year Bump Up Certificate O,p~n Date: d / (~~_ In the name of: r ~ . ~/ ~~~,f ~ Date of Death Balance: $ ~ Z Interest paid (Year to Date) from 1/1/2009 to 11/23/2009 = ~ ~U~ : Accrued Interest as of Date of Death: $ ~(/ r? not included above) Other Info. deemed relevant: ~ /7 ~' ~ ~~ ~ ~~ / n ~-- ~ ~n-ky~s ~ ~tilC r y ~w ~ ~fu CCc« ~~~ % ~°~7 ~ /~/~/o~i Susquehanna Valley FCU Estate of Mary Margaret Guilles January 12, 2010 Page 2 ~~! rlt C~ Account #55-5569 Type: S Year Bump Up Certificate O en Date: ~d ~ ~(~~ ~/ i In the name of: ~u~ ~ _ ~~~/ D~~ Date of Death Bal nce: $ Interest paid (Year to Date) from 1/1/2009. Accrued Interest as of Date of Death: $ Other Info. deemed relevant: /f7~~-~,~~ -i', i S C ~~ Gvc~.S Gi~~C ~ ~~~ Account #55-6583 Type: 5 Year Bump p Certificat ~~ /23/2009 = $ _ ~~ , ~2 (not included above) n i Open Date: / O ~~/U c/ ' r~ ~~~ C~i /~~ In the name of: (,/1 ~ ,~~ ~// Date of Death Bala ce: $ _ Interest paid (Year to Date) from 1/1/2009 to 11/22009 = $ ~~_~ Accrued Interest as of Date of Death; $ ..~ (not included above) Other Info. deemed relevant: I have provided partial information with regard to the five accounts of which I am aware. Please complete the additional information requested above for these five accounts. In addition, please provide the same information for any other accounts you identify in which the Decedent had an interest. Please respond directly to the accountant for the Estate, Richard H. Flowers, II, CPA, at 5775 Allentown Blvd. Suite 102, Harrisburg, PA 17112. If you have any questions, please contact Mr. Flowers at (717)652-6564. ~ ; ~ pl ~ ~0 °/ CD-~ ~?9~-c~ o Thank you for your prompt assistance. ~ 1C~ 1„ ~ ~~~f.. ~ / u O C~ ~ ~ ~ (,~ ~ ~, ~" I Sincerely, ~~.~ v-P s ~ Pa rrr ~'c/ a ~v, ~ ~ i I c 9 -4-0 ~ l' (~ 3 ~ cv ~7 t ~ ~ ,~~,-~ ~ ~ `zs ~~~ ,~ ~, s~ ti.. Lou Ann Guilles Executrix ~t~t~nents (~; (i awl Institution Aut ize Signature) Title: Date: - ~- Cv~~~21 - 6 ~r ~ DecLt.l~ (~-~ : I° a~ OUCH, ti~-k o~F ~n-FerP~~ ~°air~~aQ. ~ ,~~ 33 1/i / o~ -~o I i ~a 3~~{{~U `~ ,~CCi'z«~ ~c'.I U ~ ~lc~ ~ai~ ~y ~u ~ i:o5a 5U5QUEHANNA VALLEY FCU MS SUSQU~ VALDE'S~ 1?: .C:. U: 3850 HARTZDALE DRIVE CAMP HELL; gA= I T4~2==Z~09 (717)-737~4I52 MARY M GVILLES 100 -MOUNT ALLEN--DRIVE x}-212 3~ECIiANICSBURG, PA I-TOS5--fi2'T 7174412020 p.5 Member#: 55 Statement Date: 11j30f24~9 Page#: 1 P4a$1~ Code Weir Cade YTD Taxable Dividends: $1, 487 Ob YTD Tancable rnrereah:: . $_;DD.. ~'D nanee t~.ar~ges : $ _ ~~- O~`erd~~~.. Fees- T~iis- Period: ~-. OQ, Overdraft Fees YTD: $,pp. 8ettrrgeti Item _Eees Thies Pe'riacl- $-:~: Returned Item Fees YTD: $,00 Tran Post Transaction Date F2atP I2escriptioa Tran Fee FINANCE Loan ----- f 11 O1 ----- Type: -------------------- ---------- --------- 00 - REG.ULBR.SHnuF:~ On Amount.. CB~~ Ftrinep~i ---------- - g~ -- ~ I I / 3II 12REVIOU5 B1'iI+Ai7GE . __ Sg . 2g 11/01 2130- Type: 10 - LIFE SAVINGS 7u~IIRAL3CE SHAKES LgEW BALANCE- ' 5'9.2'8;; F?RF VIOUS BALANCE 4p00.00 11/O1 R7EW BALANCE 4D00,Off Type. 55 - 6583 - 5 YEAR BUMP UP CERTIFICATE Joint. with. FRED W: Gi~7fi•T,p~t ~.. SOg ~~,T,F~ 11f30 IIf3~ Dividend Posting 11/30 35.15 ESatt~it_~ Date=:_ ~ 1:42$} :'t Dividend Rate: 4.550 ~ APY , 4 _ 6S $ I1/O1 Type: Sycd - 9920 - FIVE YEAR SUMP Up Joint .with alQtiTl .N..Her-best. CERTIFICATE % 11 0 11/30 Dividend Checkn84233 11/30 26:33 26.33- Maturity Date: lOjUlj2614 Dividend Rate: 3.203 $ APY-~ ~~ g 11/01 Type: Sycd - 9921 - FIVE YEAR BUMP UP Joint... ~rxtlz Pat=icier A.._ SQ1 CERTIFICATE II/30 SIf3D Dividend Posting 11/30 11/30 Dividend Check-84234 26.33 11/3Ek. 26.33- Maturity Date: 10/01/2014 D-~vf43E?~ ~l~t~: 3 , ~g~ APY: 3.25 0 PREVIOUS BALANCE 9399.83 9434.98, NEW BALANCE 9434.98 PREVIOUS BALANCE 10000.00 2.0026.33 loooo.oo PREVIOUS BALANCE 10000.00 1.0026.33 10000.00 Thank you fQr. pour bi~iz~s~- tFits-.yea•~_ i~.;tF~t you fie- a. ehiz-ices tQ baak• e~itYt~ us- aid. we appreciate the trust that ynu place in us_ Thank you and Happy Holidays from your friends at SVFC[T! _..... - CERTIFICATE OF "f fTLE F ~ W F V _ . pR A ,. EHICLE , ,1~ ~- ~,.y a ~ ~ __ _ ~~ _. . _ .___ ~ ~ ~, ;: ~~~~ : :.... ...:;. } ' 1 ~'~~~F'i~i'ia.~~.~~"5.:5~~s3 I ~~:a'~ ,.i~ ~ i' ~ _ "~ . I ` ~ ` EHICLEIDENTIFICATION NUMBER I YE . Y#. L V r r y ~ i~~ r~l - L.1 ~9 L "~/ ~ AF ~.~ r~ti I f1 h,. ~ F VFHICL ~iT! E NUMBER o r7C DY TYcE qUF ~ ~ ~~~'~ SEAT CAP PRIDR TITLE STA7 .~~ ~ 9r I .~~~'T 't ~ ? ~ C C L ~nn _e .n ~ ~ { } ,. . C U ~' ., 'T~ r1 LE` a. Cf Jh I FOM. aTATUF ~ I ' ~~~~-F.I~~~I ~ .,. i ~.ii 'i ~ '. 4. ~ 'v. ~' ar ~,a I I ..' ~ ~ ; '. I , D EPA TITLED ~ DATt OF ISSUE ~~ UNLADEN WEIG HT ~ GVWP~ I I ==' I ' C ~ - W . I TITLE Br1ANDE ~ -- ~. GDGM~TEF. ~TATBI~ ' ~ ~~. -=.n~TJAL'MILEAG: - I i = M'LEA.,_ EXCEEO~ TI4E~~.1 - -1..,'::-. I ~ LIM!T6 -NOT TH A,^,TU.4L MILEA ~. I - NOT HE ACTWA~ MILtA ,. ~ _t. - TAMPERING VERIFIED ~C4ICTERE ~ JWNER(S) N I ~'T n 1 T U 7' -vE { = M EON OUOMET - _ ,r. -- 1 y{r ' Illi ~ ~! ~ h . ..;_.. . > , ~ ~ . , I TITLE BRANDa ~ = A lTIOUE VEHIGLo C~ ~ 1 ~~dA ~} A~ ~J ~~i14AJ~~'n1A.i~~ ~~~ ~ ~ ~- C ~COLLEGTJBCE , I - } ' of CoUN ~,7 ii ~~ pp { r ftl l~~ L~J ~"4~~~~"I'~ yy~~,qq ~ R ~ ~fYi ~ ~ ( J~~ - - _. URI.~NALLI"M r'~ 'D1STfl10UTfON N A3RfCL - LTf1RA _ L = LOGGIWG VEH -.L ' c - !S/VJAS A FO_IC= VEHICLE FgE,^,(INSTRUDTED =57iiEETROC, =RECOVEgED'THEfT VEHIGI.E1 = VEHICLECD~lTAIN5 F7EISSt1?-, I I 1 ,.~iE:J ~ ~Vnp DF, Y+=FLOOD VENIDLG ';'w SECOND LIEN. FAVDNOF =1S/WAaA~TAX~ &~'FIFo L1EfdFiE_EASEL If ~ .Second I enh0laer i5 I sled lienholder must io alo :his T'tle upon Sah5fa C11on~;o( the 1115'. Iles, the tip' .[C the Buraau of Motr~r ~Venicles rw th IhE ~ pi DATE aPProPriat=tortnentl tee. g t ;. I Mp ~ ©~. ' •~6d1 .: ' ~AUTHORIZED~REPRESENTATIVE SECOND LIEN RELEASE5 MAILING ADDRESS DATE ;ar MHr Y ~? UllILL£~ :pv _ ~~`~~ T>~~~ R~SE~9~3~T '~.~~ ~ ~ x ~ r I`J1=1r? ~l!l~lf~r'~,L~I~i ~'A FOR ~ , ~ ,;~' ~ DATE .~ ?'~~~; AlNI~ .~' TIME ~ ~~~~ .. ~ ; i nrl , ~ ~~/J 77 ~~~~~'~f-.~./i~ ~fi ; ~ N /O V I W N I OF _ ; , . # I .certify as of the tlate-ot issue,-the official reC -:of Transportation reflect -that .the persanfs) or comF~: y ~ • ;~. of the~saitl vehicle. . ., ~:..I .. I ' ' I ' '' { ~ y. 'l ~ . y., 105CRIBF~rgN06,~JRr. - )i19EFDAG~iIME '. -~- - M' OAF' _r-,NATUR~_OI'P~RSOFJ q~MINISTCRINf; 04T- ' MESSAGE _ .~ ~:: ,<~ ` ; r~ zh b k' ~ GBrt( a-al Tllle to I [ ri.t C .. I~ n et r .~ C - 1 ~ ~/~ ~ / `~ v :: ~ a ns 591IOrIM1 rlere 1 .: v Y ~. ~rv AT:IR~ OE PPPI,-1GANT OR AUTHORIZED SIGNE / /~ ,VC c/ e SIr,NATURE OF.CO-APPLIGANTRITLE OF gl1TMORIZED SIB- SIGNED •' t ~ ~ -_ ~anOC FORM 3002P l 999 Lincoln Town Car -Private Party Pricing Report -Kelley Blue Book ~~le~t ~'~u~e ~ THE TRUSTED RESiaURCE I~b,ar Page 1 of 2 Send to Printer Condition ~ Value Excellent $6,650 (Selected) Good $6,175 WHILE YOU'Rf HERE Check Out Fair $5,600 ;Vehicle Highlights ssMileage: 18,900 iEngine: V8 4.6 Liter Transmission: Automatic Drivetrain: RWD :Selected Equipment :Standard Air Conditioning Power Steering Power Windows Power Door Locks Tilt Wheel Cruise Control Traction Control AM/FM Stereo Leather Cassette Dual Power Seats Dual Front Air Bags Alloy Wheels ABS (4-Wheel) .Optional Multi Compact Disc F&R Side Air Bags :Premium Sound Moon Roof __ Blue Book Private Party Value Kelley Blue Book Private Party Value is the amount a buyer can expect to pay when buying a used car from a private party. The Private Party Value assumes the vehicle is sold "As Is" and carries no warranty (other than any remaining factory warranty). The final sale price may vary depending on the vehicle's actual condition and local market conditions. This value may also be used to derive Fair Market Value for Insurance and vehicle donation purposes. . _.._....__...__.. ___ ._ _. ____ _ e icle Condition Ratings -- ~ Excellent (selected) ~~~~~ $6,650 • Looks new, is in excellent mechanical condition and needs no Blue ~a~~C ~assfi~dsTM ~"~,,~~. - -- tdew and irn~Irc~ved Used Car listings. You just might find a deal that`s too g©ad td ~7a55 UP. ~ilsa} Yt)t!~! k> f~ ~ ~ w~ Close Window http;//www.kbb.com/kbb/L1sedCars/Pricin~Report.aspx?Action=&Yearld= 1999&Mil~°age=18900&Vehicl... 1 /28/2010 _-- -...~--..~ ~~~~~~ ~.ar signature Sedan 4D B~.UE BOQ1(~ ~R~YATE PARTY VALUE __ advertisement 1999 Lincoln Town Car -Private Party Pricing Report -Kelley Blue Book reconditioning. • Never had any paint or body work and is free of rust, • Clean title history and will pass a smog and safety Inspection. • Engine compartment is clean, with no fluid leaks and is free of any wear or visible defects. • Complete and verifiable service records. Less than 5% of all used vehicles fall into this category. Good ~3i"'~";~ $6,175 • Free of any major defects. • Clean title history, the paints, body, and interior have only minor (if any) blemishes, and there are no major mechanical problems. • Little or no rust on this vehicle. • Tires match and have substantial tread wear left. • A "good" vehicle will need some reconditioning to be sold at retail. Most consumer owned vehicles fall into this category. Fair `'~ $5,600 • Some mechanical or cosmetic defects and needs servicing but is still in reasonable running condition. • Clean title history, the paint, body and/or interior need work performed by a professional. • Tires may need to be replaced. • There may be some repairable rust damage. Poor N/A • Severe mechanical and/or cosmetic defects and is in poor running condition. • May have problems that cannot be readily fixed such as a damaged frame or crusted-through body. • Branded title (salvage, flood, etc.) or unsubstantiated mileage. Kelley Blue Book does not attempt to report a value on a "poor" vehicle because the value of these vehicles varies greatly. A vehicle in poor condition may require an independent appraisal to determine its value. * New York 1/28/2010 Page 2 of 2 http://www.kbb.com/kbb/UsedCars/PricingReport.aspx?Action=&Yearld=1999&Mileage=18900&Vehicl... 1 /28/2010 r , v,,, ~<n April 2009 C'(1MMON1>t'f~.~1LTlI Of ~'LNNSI"LV'.~\Nln r~u~i~ic scHOOi. ~mr>i~c>!~~rrs~ u~T~rz~iv~rn~.r ~~-sT,rn~ A/ailin~;~ ; I drh•e.~~.' 7~0//-1-i•r~r - I -SS?~-~? ;-,74t~ ['U f3aT I?~ (I-f~hti'-I'SIiRS4Ul H~irrisbure I'A I IIOf~-O,?~ Local- 71 %-7};7-f;i4U Nzr6 Adtb~e~s: mrrrr.n.ecr~.c.~7mc~ nu uc r,!z;;-;~~ l~ ;L TLLEti C,'. ;~tJ~EMOiVT FVE N~[nI _ :IMB~,P.L=~1\1D P~, 1 ~ 0~0-~'.i5 /SuilrGrr;~ Location Nnrtii Atli Sired [ larrishurr !'A 5 ,~±~'v`J ~--- ~~~~~~~~ - ~`~ ,~~ . Jam' a'~~ ~ 1.~~ ~ I S.S.# XXX-1X-9?~;? Dear- MARY M GUILLES: As a reminder, you will receive this type of benefit breakdown letter each time there is a change in the amount of your gross and/or net benefit amount. If you wish to access information about your benefit breakdown in other months when a change does not occur, you may do so on-line at the PSERS website www.osers.state pa us after establishing a secure Inter(n~ction member account by following the directions provided. - The federal economic stimulus package, the "American Recovery and F'.einvestment Act," included revisions to federal withholding tax tables. Your Federal Withholding deduction may have been impacted as a result. The new withholding tables could result in an individual tax shortfall for some in ~a09. You may want to consult with a qualified tax professional to determine if this will have an impact on your tax liability at the end of the year. - Over - OLOOC92820532 Effective April 30, 2009 your Public School Employees' Retirement System (PSERS) monthly benefit will change. The following table compares your March 31, 2009 monthly benefit to your April 30; 2009 monthly benefit: naomeowners porky retund Allstate Insurance Company .0H75 David l aNor Ur Charlotte, NC 2&262-]046 IInII~~IIiIIiLIIJ~I~~~~~IIII~~L'~~~n~~~~n~ll~l~lill~llllll' ESTATE OF MARY GUILLES LOU ANN GUILLES 128 MELBOURNE LN MECHANICSBURG PA 17055-6673 What you should know As you requested, we have terminated your policy effective November 17, 2009. Attached is your refund check. We thank you for the opportunity to serve you and hope we can provide your insurance protection in the future. If you have any questions, please contact your agent or producer of record. Payment history 3/16/09 Previous balance $509.45 3/26/09 Payment received - 509.45 1/4/10 Policy cancellation adjustment - 194.00 1/4/10 Refund issued 194.00 ,:~-. I/ ~" Balance $0.00 ~:~~: ~ f „ i I i?~ I'_ fi . ~ '~,,~ Information as of January 4, 2010 Policyholder Page 7 of 1 Estate of Mary Guilles Lou Ann Guilles Polic number 05Z 729136 Property 807 ROSEMONT AVENUE NEW CUMBERLAND PA 17070 Your Allstate agency is Jannene Miller Agy 6415 Carlisle Pike Mechanicsburg, PA 17050 (717) 766-0951 Marsh Global Consumer a service of Seabury & Smith, Inc. 12421 Meredith Drive, Urbandale, IA 50398 515-243-1776 1VEA1 Members Insurance Trusf CHECK NUMBER 95862 CERT NUMBER NAME CHECK DATE BATCH REQUESTOR DATE APPLIED REFUND AMOUNT 802320010890. ESTATE OF MARY M GUILLES 01/15/2010 8020 CR2802407 01/15/2010 58.00 Marsh Global Consumer a service of Seabury & Smith, Inc. 12421 Meredith Drive, Urbandale, IA 50398 515-243-1776 NF.A Members Insurance Trust° CERT NUMBER NAME CHECK DATE BATCH REQUESTOR DATE APPLIED REFUND AMOUNT 802020011633 ESTATE OF MARY M GUILLES 02/05/2010 8020 ~CR2802401 02/05/2010 $5.47 INwd1~~1~~~W~~~tla~A~~~E~~~~~~'~~'~~I~I~WII~A J 235429282 GUILLES MARY 128 MELBOURNE LANE MECHANICSBURG 0900112178 PA-40 - 2009 Pennsylvania Income Tax Return ENTER ONE LETTER OR NUMBER IN EACH BOX. Do Not Use Your Preprinted Label N Extension. N Amended Return. M Occupation DECEASED R Resioency Status. PA Resident/Nonresident/Part-Year Resident Occupation from to D SinglE;/Married, Filing Jointly/Married, Filing Separately/Final Return/Deceased Date of death 112 3 D 9 N Farmers. P A 17 0 5 5 School District Name WEST S H O R E 21900 1 a Gross Compensation. Do not include exempt income, such as combat zone pay and qualifying retirement benefits. See the instructions. 1 b Unreimbursed Employee Business Expenses. 1c Net Compensation. Subtract Line lb from Line la. 2 Interest Income. Complete PA Schedule A if required. 3 Dividend and Capital Gains Distributions Income. Complete PA Schedule B if required. 4 Net Income or Loss from the Operation of a Business, Profession or Farm. 5 Net Gain or Loss from the Sale, Exchange or Disposition of Property: 6 Net Income or Loss from Rents, Royalties, Patents or Copyrights. 7 Estate or Trust Income. Complete and submit PA Schedule J. 8 Gambling and Lottery Winnings. Complete and submit PA Schedule T. 9 Total PA Taxable Income. Add only the positive income amounts from Lines lc, 2, 3, 4, 5, 6, 7 and 8. DO NOT ADD any losses reported on Lines 4, 5 or 6. 10 Other Deductions. Enter the appropriate code for the type of deduction. See the instructions for additional information. 11 Adjusted PA Taxable Income. Subtract Line 10 from Line 9. PAIA0412L 12/24/09 EC Page 1 of 2 FC 1a 0 1b 0 1c 0 2 1659 ~ 3 4369 /~ 4 D 5 0 6 0 7 0 8 0 9 6028 10 0 11 6028 09001121,78 ~ m 0900112178 _J 0900212186 PA-40 - 2009 Social Security Number ~' 235429282 Name(s) GUILLES, MARY M. 12 PA Tax Liability. Multiply Line 11 by 3.07 percent (0.0307). 13 Total PA Tax Withheld. See the instructions. 14 Credit from your 2008 PA Income Tax return. 15 2009 Estimated Installment Payments. 16 2009 Extension Payment. 17 Nonresident Tax Withheld from your PA Schedule(s) NRK-1. (Nonresidents only) 18 Total Estimated Payments and Credits. Add Lines 14, 15, 16 and 17. Tax Forgiveness Credit. Submit PA Schedule SP. 19a Filing Status: 01 Unmarried or Separated 02 Married 03 Deceased 19b Dependents, Part B, Line 2, PA Schedule SP 20 Total Eligibility Income from Part C, Line 11, PA Schedule SP. 21 Tax Forgiveness Credit from Part D, Line 16, PA Schedule SP. 22 Resident Credit. Submit your PA Schedule(s) G-R with your PA Schedule(s) G-S, G-Land/or RK-1. 23 Total Other Credits. Submit your PA Schedule OC. 24 TOTAL PAYMENTS and CREDITS. Add Lines 13, 18, 21, 22 and 23. 25 TAX DUE. If Line 12 is more than Line 24, enter the difference here. 26 Penalties and Interest. See the instructions. Enter code: If including form REV-1630, mark the box. N 27 TOTAL PAYMENT DUE. See the instructions. 28 OVERPAYMENT. If Line 24 is more than the total of Line 12 and Line 26, enter the difference here. The total of Lines 29 through 35 must equal Line 28. 29 Refund -Amount of Line 28 you want as a check mailed to you. Refund 30 Credit -Amount of Line 28 you want as a credit to your 2010 estimated account. 31 Amount of Line 28 you want to donate to the Wild Resource Conservation Fund. 32 Amount of Line 28 you want to donate to the Military Family Relief Assistance Program. 33 Amount of Line 28 you want to donate to the Governor Robert P. Casey Memorial Organ and Tissue Donation Awareness Trust Fund. 34 Amount of Line 28 you want to donate to the Juvenile (Type 1) Diabetes Cure Research Fund. 35 Amount of Line 28 you want to donate to the PA Breast Cancer Coalition's Breast and Cervical Cancer Research Fund. Signature(s). Under penalties of perjury, I (we) declare that I (we) haveexamined this return, including all accompanying schedules and statements, and to the best of my (our) belief, they are true, correct, and complete. Your Signature I Spouse's Signature, if filing jointly Preparer's Name and Telephone Number (717) - 5 564 Date Flowers & Flowers CPAs ~ !/ ~~ 3 ~ J 5775 Allentown Blvd., Ste. .0 - H rrisb ~ !, 312 1 ~' 18 5 1.I p 14 2 15 118 16 p 17 p 18 120 19a 03 19b oa 2Q 6729 21 167 22 p 23 p 24 287 25 p 26 p 27 p 28 102 2 9 102 30 p 31 p 32 p 33 p 34 Q 35 p Firm FEIN Preparer's SSN/PTIN 232935345 POO529OO9 09OQ212186 Pac~e2of2 0900212186 PAIA04 2L 12/24/09 Deceased Form ~ O~}O Label (See instructions) Use the IRS label. Otherwise, please rent Mary M. Guilles 11/23/09 Department of the Treasury -Internal Revenue Service U.S. Individual Income Tax Return Z~~9 For the year Jan 1 Dec 31 2009 or other tax year beginning 2009 endin Your fust name MI Last name Mary M. Guilles If a joint return, spouse s first name MI Last name Lou Ann Guilles, Executrix Home address (number and street). It you have a P.O, box see instructio ~ /~r~ /~ ~~/ IRS Use Only - Do not write or staple in this space 20 OMB No. 1545-0074 Your social security number 235-42-9282 ~ Spouse's social security number or type. ns. 128 Melbourne Lane Apartment no. You must enter your City, town or post office. If you have a foreign address, see instructions. social security . number(s) above State ZIP d Ele t onntial Mechanicsbur PA 17055 . co e Checking a box below will not Campaign ' Check here ii you, or your spouse if filing jointl want $3 t t h change your tax or refund. y, o go o t is fund? (see instructions)..... • • • ... - ~ You ~ Spouse Filing Status 1 X Single 2 4 Married filing jointly (even if onl one had income y ) Head of household with ualif in instructions.) If the (ualifQin y g person). (See q Check only 3 Married filing separately. Enter spouse's SSN above & full y g person is a child but not your `ependent, enter this child's one box. name here - name here. _ Exemptions 6a X . 5 Qualif in widower with dependent child (see instructions) Yourself. If someone can clai b m you as a dependent, do n Boxes checked ot check box 6a .. . Spouse ................................. ...... ~ on 6a and6b., 1 ............. c Dependents: (2) Dependent's ......... " " " " " " (3) Dependent:'s ' ~ No, of children (4) ;f on 6c who: social security relationship qualifying ~ lived number (1) First name Last name t0 OU y child for child with you.... . tax credit • did not (see instrs) live with you If more due to divorce than four dependents, or separation (see instrs).. , see instructions Dependents on 6c not ^ and check here - errtered above. d Total number of exemptions claimed .......... Add numbers on lines ............. 7 Wages salaries ti t ....... ................... .... above.... - 1 Income , , ps, e c. Attach Form(s) W-2 .......... . ga Taxable interest. Attach Schedule B if required ........................................ 8a bTax-exempt interest Do not include li 8 1, 659. ~ Attach Form(s) W•2 here. Atso . on ne a ......... a Ordinary dividends. Attach Schedule B if required ....... b Qualified dividends (see instrs) .... I 8b~ ............................... ~ "~'~~' :»::>:;::::;: 9a 4, 369. attach Forms W-ZG and 1099-R I tax was withheld. ................................. I 9b~ 4 369. 10 Taxable refunds, credits, or offsets of state and local income taxes (see instructions) ...... ................ 11 Alimony received :.. ° "~~' 10 ; ~ ............... ........... ........... 12 Business income or (loss) Att h S ..... ........................ 11 If you did not get a W-2 . ac chedule C or C-EZ ... 13 Capital gain or (loss) Att Sch D if r d If t .............................. 12 , see instructions. . eg . no regd, ck here .......... 14 Other gains or (losses) Att h F 47 ............... - ~ 13 . ac 15a IRA distributions orm 15 97 .............. . . ........................... 14 ............. a bTaxable amount (see instrs) 15b 16a Pensions and annuities 16 .. ...... a 22, 404. bTaxable amount (see instrs) 16b 17 Rental real estate ro alties t ... 21 799. r Enclose, but do , y , par nerships, S corporations, 18 Farm income or (loss) Attach Sch d l F trusts, etc. Attach Schedule E .. 17 not attach, any . e u e ............... 19 Unemployment compensation in excess of $2,400 per recipient (see instructions) ........... . • ~ • ~ • • ~ • ~ • - - • • • ~ . 18 payment. Also, please use .................... 20a Social security benefits ~ 20 ~ 1 ...... .. .... 19 Form 1040-V. ........... a 6, 779 21 Other income bTaxable amount (see instrs) .. 20b 6 384 . r ---- ___________ 22 Add the amounts in the far right column for lines 7 through 21 This is our tot l i - 21 ^^ . y a ncome. , • ~- 23 Adjusted Educator expenses (see instructions) ..................... 23 24 Gr055 Certain business expenses of reservists, performing artists, and fee-basis It1COme government officials. Attach form ZI06 or 2106-EZ .................. . 24 25 Health savings account deduction. Attach Form 8889....... . 25 ' 26 Moving expenses. Attach Form 3903 ..................... . 26 27 One-half of self-employment tax. Attach Schedule SE...... . 27 28 Self-employed SEP, SIMPLE, and qualified plans.......... . 28 29 Self-employed health insurance deduction (see instructions) ............ . 29 30 Penalty on early withdrawal of savings ..................... :; 3D 31 a Alimony paid b Recipient's SSN .... - .. 31 a ;: 32 IRA deduction (see instructions) ........................... 32 '> 33 Student loan interest deduction (see instructions)........... :<: 33 :': : 34 Tuition and fees deduction. Attach Form 8917 .............. >: 34 35 Domestic production activities deduction. Attach form 8903 ............. :. 35 ~" <: Add lines 23 - 31a and 32 - 35 .................................. .. . 37 ....................... . Subtract line 36 from line 22. This is our adjusted rocs income - BAA For Disclosure, Pri vacy Act, and Paperwork Reduction Act Notice, see instructions. FDlnot t;?L 09/17/09 0. J4,L11. Form 1040 (2009) orm 1040 (2009) Mary M. Guilles 235- 42-9282 Pa e 2 Tax and 38 Amount from Ilne 37 (adjusted gross income) ............... 38 34 39 ................... Ch J X ........ , 211 . Credits a eck if: B You were born before January 2, 1945, B Blind. Total boxes '' ''•~ ' L Spouse was born before January 2, 1945, Blind. checked ~ 39a 1 !"''' Standard Deduction b If your spouse itemizes on a separate return, or you were adual-status alien, see instrs and ck here. ~ 39b :::::»:'.>".#: ;;,;;<:. :: for - • Peo le who 40 a Itemized deductions (from Schedule A) or your standard deduction (see left margin) .............. b If i i ....... 40a ; 7, 600 . p you are ncreas ng your standard deduction by certain real estate taxes new motor vehicle taxes or check any box li 39 39 , , a net disaster loss, attach Schedule L and check here (see instructions) ................... ~ 40b X^ on ne a, b, or40borwho 41 Subtract line 40a from line 38 .......................................... . ~~•• ••.••.. 41 26,611. can be claimed 42 Exemptions. If line 38 is $125,100 or less and you did not provide housing to a Midwestern displaced :~»::'>:< as a dependent, Individual, multiply $3,650 by the number on line 6d. Otherwise, see Instructions .......... 42 3 650 i i 43 ........ Taxable incom S bt t li 42 f l ....... , . see nstruct ons. • A e. u rac ne rom ine 41. If line 42 is more than line 41, enter -0- . .............................................. ....... 43 22 , 961. ll others: 44 Tax (see instrs). Check if any tax is from: a 8 Form(s) 8814 Single or Married 45 b Al Form 4972 .................... ....... 44 2, 369. filing separately, 700 $5 46 ternative minimum tax (see instructions). Attach Form 6251 .................... A ....... 45 0 . , dd lines 44 and 45 ......................................................... ..... ~ 46 2 3 6 9. Married filing 47 Foreign tax credit. Attach Form 1116 if required ............. 47 .::::::.::.;: :::>s::>:<::> :: jointly or 48 Credit for child and dependent care expenses. Attach Form 2441.......... 48 . ~`'" ~'''~ ~'? Qualifying 49 Education credits from Form 8863 line 29 49 widow(er) , ............ , $11,400 50 Retirement savin s contributions credit. Attach Form 8880... 9 50 Head of 51 Child tax credit (see instructions) ............. 51 `'"'`~ ~' household, 52 Credits from Form: a ~ 8396 b 8839 c 5695...... 52 $8,350 53 Other crs from Form: a ~ 3800 b ~ 8801 c ~ 53 54 Add lines 47 through 53. These are your total credits ........ ..... .............. ....... 54 55 Subtract line 54 from line 46. If line 54 is more than line 46, enter -0-. ............ ..... ~ 55 2, 369. 56 Self-employment tax. Attach Schedule SE .............................................. ....... 56 Other 57 Unreported social security and Medicare tax from Form: a ~ 4137 b ~ 8919 ............... ....... 57 Taxes 58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required ............ ... 58 59 Additional taxes: a ~ AEIC payments b ~ Household employment taxes. Attach Schedule li.... ....... 59 60 Add lines 55-59. This is your total tax ........ ~ 60 2 3 6 9 Payments 61 Federal income tax withheld from Forms W-2 and 1099...... 61 1, 676 .N?'''' :.;:.;»::... 62 2009 estimated tax payments and amount applied from 2008 return........ 62 1, 010 .'?'> 63 Making work pay and government retiree credit. Attach Schedule M........ 63 ~€«''.>? If you have a :_:;.;;p;; quallfying 64a Earned income credit(EIC) ............................... 64a :~':::::>::::>: :;:::::>i>.>.: .......... c I d, a ach b Nontaxable combat pay election..... ~ 64b ~~~'~~~~`~~ :::::>::»:::>: Schedule EIC. :;;::;;::;::;; 65 Additional child tax credit. Attach Form 8812 ............... 65 :::>::::<::: 66 Refundable education credit from Form 8863, line 16........ 66 ~> 67 First-time homebuyer credit. Attach Form 5405 ............. 67 ::»>:>:<::: 68 Amount paid with request for extension to file (see instructions).......... 68 69 Excess social security and tier 1 RRTA tax withheld (see instructions) ...... 69 70 Credits from Form: a ~ 2439 b ~ 4136 c ~ 8801 d ~ 8885. , 70 .::.....::. 71 Add Ins 61-63, 64a, & 65-70. These are your total pmts ......................................... ~ 71 2, 686 . Refund 72 If line 71 is more than line 60, subtract line 60 from line Il. This is the amount you overpaid ................ 72 317 . Direct deposit? 73a Amount of line 72 you want refunded to ou. If Form 8888 is attached, check here .. ~ ~ 73a 317 . See instructions : :>;:>::::::>:: b Routing number........ XXXXXXXXXX c T e: Checking ^ Savings :;;:;;::;:;:: and fill in 73b, . d Account number........ XXXXXXXXXXXXXXXXXXXXXXXX ...... 73c, and 73d or Form 8888. 74 Amount of Ijne 72 you want applied to your 2010 estimated tax........ ~ 74 :::: :::::::. AmOUnt 75 Amount you owe. Subtract line 71 from line 60. For details on how to pay, see instructions ................ ~ 75 You Owe :>:<:::»>::>: «::<:::::::>:<::«:::>::>:::<::<:>:<:::;»>::::>::>::;::::>;>: 76 Estimated tax penalty (see instructions) .................... 76 ;;;<;;:;:::;:::;;:;::;::;:;::;:;;;;;:; :;:;:;;:;~~;:;:;;:;:;:;::; Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)2 .......... X Yes. Complete the following. No Designee Demenee's ~ Richard H. Flowers II Pohone ~ 717-652--6564 P`armsboena(Pi~tification ~ 05775 SI n Under penalties of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowledge and 9 belief, they are true, correct, and complete. Declaration of preparer (other than taxpayer) is based on all information of which preparer has any knowledge. Here Your si nature Joint return? g Date Your occupation Daytime phone number See instructions. / Deceased Spouse's signature. If a joint return, both must sign. Date Spouse's occupation Keep a cop Y f r or o r reco ds u Y /~ /f' ... ................................................. / / Date Preparer's SSN or PTW Paid Prgeparer's ,-'.~/r~/ ,~1Z, ~/~ ~/ / Q• P Y si nature ~I~ 7 j/j/J~{ ~ Check if self-em to ed P 0 0 5 2 9 0 0 9 Preparer's Fim,'s name Flowers & F owers CP (or yours if Ste. 102 EIN 23-2935345 Use Only self-employed)] 5775 Allentown Blvd. , ZldPcodeand Harrisburg, PA 17112 Phone no. (717) 652-6564 Form 1040 (2009) FDIA0112~ 09/17/09 NATIONAL GEOGRAPHIC SOCi ETY 3000 University Center Drive Tampa, FL 33612-6408 PAY $eueorteeo: 8c - t=:., No. 200365 DATE: 12/15/09 63-2/630 FOR TRAVELER - AC#:427893562 REASON: CANCEL ORDER MARY M GUILLES-ESTATE of 128 MELBOURNE LN MECHANICSBURG PA 17055-6673 Il~lll~~nnll~llllh~hllll~llrl~llllll~ll~l~llnflinl~il~~ll~ VOID AFTER 90 DAYS 11'0000 20036511' x:0630000 2 ~~: 20000 27334 2 2311' Estate of: Mary M. Guilles D.O.D. 11-23-2009 File No. 21-09-1153 ATTACHMENTS TO: Pennsylvania Inheritance Tax Return Form REV-1509 Schedule F Jointly Owned Property January 12, 2010 Susquehanna Valley FCU 3850 Hartzdale Drive Camp Hill, PA 17011-7809 RE: Estate of Mary Margaret Guilles Social Security #: 235-42-9282 Date of Death: November 23, 2009 Member # 55 To whom it may concern: I am the Executrix for the Estate of Mary Margaret Guilles who died on November 23, 2009. Attached please find a Letter of Testamentary and a Death Certificate. Please provide the following information with regard to the following accounts or any other accounts the Decedent held with PNC Bank, on or near the Date of Death of November 23, 2009: Account #00 Type: Regular Shares Open Date: 7 d/ ~`,j In the name of: ./"' ~ (~(~ / Date of Death Bal ce: $ - , a~~ Interest paid (Year to Date) from 1/1/2009 to 11/23/2009 = $ ~ ~ . a S Accrued Interest as of Date of /Death: $ (not included above) ,q c~f- Other Info. deemed relevant: rh~i~ WSJ rig fC/-~s /- -err ~f ~ .~ # S ~--/ O Mary chose the ,n fr~-~.1 ¢ ~- ~h P Li' P sF ~~ X95 R cc ~ fo~v ~ Py~;c /av ~5~~/ Account #10 Type: Life Savines Insurance Shares Open Date: A In the name of: /(r~, / /~ Date of Death B ance: $ ~- Interest paid (Year to Date) from 1/1/2009 to 123/2009 = $ `~ ~_ Accrued Interest as of Date of Death: $ ~ ~ 3 (not included above) Other Info. deemed relevant: Account #55-5568 Type: S_Year Bump Up Certificate Op~n Date: d I (,~ In the name of: r ~ . ~/ ~~-PJ' / Date of Death Balance: $ ~ Z Interest paid (Year to Date) from 1/1/2009 to 11/23/2009 = $ Ou ,_ Accrued Interest as of Date of Death: $ ~(/ ~ not included above) Other Info. deemed relevant: /7 !7 /`' G~ r~ ~ ~7 ,r r, /~ ~ n ->~y~.s t ({~~ v y Chi ~ ~ CCc« ~~~ ,% /-~~~~~~ ~l ~ ~S C O iv Cc~S o ri9~hGc..Q o ~2r~~c,~ G~'L /G7/~~ ~O ~~ 1~~0~/ Susquehanna Valley FCU Estate of Mary Margaret Guilles January 12, 2010 Page 2 Account#55-5569 i~l~/~r1~7 ca Type:S Year Bump Up Certificate ~n Date: ~d ~ ~U . i In the name of: ~i'2~C,,~- /(~ . ~~~~/ ~~~ Date of Death Bal nc~ e: $ Interest paid (Year to Date) from 1/1/2009 Accrued Interest as of Date of Death: $ ~--~ Other Info. deemed relevant: %/7~r-~,J• ~ i Account #55-6583 Type:S Year Bump p Certifica a~11/23/2009 = $ " ~~~ (not included above) In the name of: (i1, r - ,~~~// Date of Death Bala ce: $ Interest paid (Year to Date) from 1/1/2009 to 1~ 2009 = $ ~~~ Accrued Interest as of Date of Death: $ ..._- (not includecl above) Other Info. deemed relevant: ~L2R/T /IO?7 I have provided partial information with regard to the five accounts of which I am aware. Please complete the additional information requested above for these five accounts. In addition, please provide the same information for any other accounts you ia~entify in which the Decedent had an interest. Please respond directly to the accountant for the Estate, Richard H. Flowers, II, CPA, at 5775 Allentown Blvd. Suite 102, Harrisburg, PA 17112. If you have any questions, please contact Mr. Flowers at (717)652-6564. ~~ ; /O/ ~ ~U °J Thank you for your prompt assistance. ~~ CDC (~~~~ ~ ~ ~ lr~ ~ ~Jo h n (~e.~~ u G~ p ~~ i~-K ~~ 'P~c~S? ~~" 3 3 Sincerely, c' ~ ~~~ ---~ S ~ P~ v~ ~c('~v a ~~ ~/ ,lop -{-o ~c(~3~ o ~ Lou Ann Guilles Executrix A~t~Ch~nents (?~ (~~I Institution Aut ize Signature) Title: Date: - G~#~~21 - ~ ~` sx~-k o~ Dect~.lti. (~'~ : f OJ DDS, -~ :~n-fe r-e.1~ C°ain~cC. /~ 3~ f Cf'zC D~ Cf J D ~ 1~ a~ ~~ ~~ ~~ .• ;5,3, reh w~G/ ~"~j ~/ ~'t ~a/i /ora, %f Q to Open Date: Estate of: Mary M. Guilles D.O.D. 11-23-2009 File No. 21-09-1153 ATTACHMENTS TO: Pennsylvania Inheritance Tax Return Form REV-1510 Schedule G Inter-Vivos Transfers and Miscellaneous Non-Probate Property -r ~r ~.,,~ 2:F~PP~ ~ ~, ~„ ~~ ~aa~HSr~~w~r 1'anuary 20, 2010 PNC E,4NK 41?-705-~i4i (~ PN C BANK Amanda Li 52$8 Simpson Ferry Rd Mechanicsburg, PA 17050 RE: Name: Mary M Guilles SSN: 235-42-9282 DOD: 11 23-2009 Dear Ms. Li: u~. S~sS P. v1 Amanda Li Financial Sales Consultant T 717-697-3015 F 717-795-6187 amanda.li@pnc.com Member of The IPNC Financial Services Group 5288 Simpson Ferry Road Mechanicsburg Pennsylvania 17050 In response to your request for Date of Death (DaD) .balances for the custazner noted shave, our records show the following: Checlwig Account Account # 5005059485 Established: 06-09-2009 MARX M [TU1LL$S LOU ANN GUILLES DOD balance: $151,231.89 + 11.11 accrued interest Interest paid 01-01-2009 thru 11-23-2009 $57.37 YTD Account # 5140025253 Established: 10.01-1960 MARY M GUiLLES DOD balance: $6,201.00 non interest bearing Savings Account Account # 5004396121 Established: 02-04-2004 MARY M GUII..LES DOD balance: $27,921.90 + 10.4b accrued interest Irterestpaid QI-O1-2009 thrt' 11-23-2009 $138.51 YTD Please Hate that this office provides date of death balances far deposit accounts (IKAs, CDs, Checking and Savings}. We do not ,process soy financial transactions or provide statements. ffyou need assistance with any of these items, please call 1-888-PNC-I3ANK (1-888-762-2265) or stop by your local PNC Bank branch office. Singly, National Financial Services Center PNC Bank; N.A. Member FDIC Page 1 of 1 Performance Checking Account Statement PNC Lank v For tl~o period 10/29/2009 to 11 /25/2009 MARY M GUILLES LOU ANN GUILLES 212 MESSIAH CIR MECHANICSBURG PA 17055-8619 ~` PN C BANK Pnmary account rnrmber: 50-0505-9485 Page 1 of 2 Nt,~mber of enclosures: 0 C~ For 24-liotrr banking, and transaction or 3interest rate information, sign on to PNC Bank Online Banking at pnc.com. a" For ctrstorner service call 1-888-PNC-BANK Monday -Friday; 7 AM - 10 PM ET Saturday & Sunday: 8 AM - 5 PM ET Para servicio en espanol, 1-866-HOLA-PNC Moving? Please contact trs at 1-886-PNC-BANK ® Write to: Customer Service PO Box 609 Pittsburgh PA 15230-9738 Visit trs at pnc.com TDD terminal: 1-800-531-1648 For hearing imPnired clients only Your everyday banking and purchases just got more rewarding with PNC points(sm). Use your PNC VisaU~ Check Card and points Visa credit cards'. Earn points. Pay a bill online. Earn points. Elect to receive your checking account statement online. Earn points. Enroll today at pnc.com/points or call 1-888-PNC-points. See how quickly you earn rewards! And, the best part...it's free! "Subject to credit approval. Note: PNC Bank Select Rewards Visa Platinum, Visa Signature Rewards, and Visa Platinum Credit Cards are not eligible for enrollment in the PNC points program at this time. The new points Visas credit cards will be available to customers 1 1 /9/09. PNC points is a service mark of The PNC Financial Services Group, Inc. PNC Bank reserves the right to change or terminate the PNC points program. See Terms and Conditions for complete details o..v^...a^^^^;e a.necK~ng Interest Checking Account Summary Mary M Guilles Lou Ann Guilles Account ntrrnber: 50-0505-9485 Overdraft Protection Provided By: Contact PNC to establish Overdrak Protection Balance Summary Beginning Deposits and Checks and other balance other additions Ending deductions balance 51,5Ci3.G2 99,691.45 .00 151,245.07 Average monthly Charges balance and fees 80,345.9G .00 Interest Summary As of 11/25, a total of $70.55 in interest was Annual Percentage Number of days Average collected paid this year. Yield Earned (APYE) in interest period balance for APYE Interest Paid this period 0•22i 28 76,809.50 13.18 Activity Detail Deposits and Other Additions Date Amount Description 11/02 255.55 Direct Deposit - DcO1DD0911 Verizon Communic Cxxxx,U:047GVzn 11/02 248.31 Direct Deposit -Civil Serv US Treasury 312 F 2871950 bV CSF 11/Ori r2 Gg Deposit Reference No 520717193 ] 1/18 99,121.75 Deposit Preference No 526267399 There were 5 Deposits and Other Additions ~~totaling $99,691.45. rlanncit¢ and rlthar Arl rlirinnc enntinna`i nn novr nano FORM953R-1005 Performa~.iceChecking Account Statement For 24-Hour information, sign on to PNC Bank Online Banking on pnc.corn. Account. number: 50-Ob05-4485 - continued Deposits and Other Additionta -continued Date Amount Descrlptlon 11/20 13.18 Interest Payment .Daily Balance Detail Date Balance Date 10/29 51,5ri3.62 11/05 11/02 52,057.48 11/18 Balance Date 52,1 ] 0.14 11/25 151,231.89 `Far tl~e period 10/Z9/2009 to 11/25/2009 MARY M GUILLES Primary account number: 50-0505-9485 Page 2 of 2 Balance 151,245.07 0.00 ~ 151,231-~30~~+ /~~( 151 X243-00 fi h'CryryJ T L VArylA .1"rytltKl 1 H1'1L.G I H/l ;~ ~'~ ~ ~ ~C~GI~ ^ ~~ INFDRMAT:IDN NOTICE BUREAU DF INDIVIDUAL Taxes AND FILE ND , 21 PD BOX 280601 HARRISBURG PA 17128-oeol TAXPAY.E•R ~RE.SPONSE ACN 09180466 RfiV-1e43 E% AFP (OB-BB) DATE 12 - 22 - 2 D D 9 ~* LOU A GUILLES .128 MELBOURNE LN MECHANICSBURG PA 17055-667.3 :EST. OF MARY M GUILLES SSN .235-42-9282 :DATE OF :DEATH _1.1-23-2DD9 COUNTY CUMBERLAND REMIT PAYMENT AND FORMS T0: REGISTER OF-WILLS CUMBERLAND CD COURT HOUSE CARLISLE, PA 17iD13 TYPE OF "ACCOUNT SAVINGS ® CHECKING TRUST CERTIF. PNC BANK NA provided the Department with the information below, which has been used in calculating the potential tax due, Records lndicate that at the death of the above-named decedent, you were •a joint. owner/beneficiary of this account. If you feel the information is incorrect, please obtain written correction from the financial instii:ution, attach a copy to this form and return it to the above address. This account is taxable in accordence~with the Inheritance Tex .laws of the Commonwealth of Pennsylvania. Please call C717) 787-8327 with questions. COMPLETE PART .1 BELOW ~ SEE REVERSE SIDE FDR FIL'IN6 AND PAYMENT .INSTRUCTIONS Account No. 0D0D05005059485 Date 06-09-2009 To ensure proper credit to the account, two Established copies of this notice must accompany Account Balance ;$ .148,.231 .89 payment to the Register of Wills. Make check payable to "Register of Wills, Agent". Percent Taxable X .100.00 Amount Subject to 'T ax $` .148,231.89 NOTE: If tax payments are nade-within three months of the decedent's date of death, 'Tax Rate X . 045 deduct -a 5 percent discount on the tax due. Potential 'T ax Due $ 6,6.70.44 Any Inheritance Tax due .will become delinquent nine •months.after-tha data of death. PART TAXPAYER ~RESP,DNSE 1 A. ~ The above information end tax due is correct. Remit payment to the Register of Wills with two copies of this notice to obtain CHECK a discount or .avoid interest, or check box "A".end return this notice to 'the Register of ON E Wills and an official assessment.will be issued by the PA Department of Revenue. B L D C K ~ B. The above asset has been or will .be reported .and-tax paid .with the P ON L Y ~"''to be filed by the estate representative. ennsylvania Inheritance Tax return C. ~ The above informs ion is incorrect and/or debts end deductions were paid. Complete PART 2~ and/or PART 3L_I below. PART If indicating a different tax rate, please state relationship to decedent: TAX RETURN - COMPUTATION LINE 1.-Date Established 2. Account Balance 3. Percent Taxable 4. Amount Subject to Tax 5. Debts and Deductions 6. Amount Taxable 7. Tax Rate 8. Tax Due PART DATE PAID PAYEE G 1~~~~i~ DF TAX ON JOINT/TRUST ACCOUNTS 1 2 +fi 3 X 4 $ 5 '~ 6 7 X 8 +~ DEBTS AND DEDUCTIONS CLAIMED DESCRIPTION AMOUNT PAID TOTAL CEnter on Line 5 of Tax Computation) 8 Under penalties of perjury, I declare that the facts I have reported above are true, correc/t/ and complete the best of my n wledge and belief. ~ / o _ 6L0'7' HOME C r7(7 ) l~ O WORK C ) - -Zl!(b TA AYE SIGNATURE TELEPHONE NUMBER DATE V MIDLAND NATIONAL `Life Insurance Company A~znuities at their Best March 11, 2010 FLOWERS AND FLOWERS C/O RICHARD FLOWERS 5775 ALLENTOWN BLVD STE 102 HARRISBURG PA 17112 **712 better** Re: Mary M Guilles, deceased. Policy: 8500176079 Beneficiaries: Lou Ann Guilles Dear Mr. Flowers: This contract is an Annuity. Below is the information that is needed to complete the estate tax return. Decedent: Mary M Guilles Social Security Number: 235-54-9282 Date of Issue: 4/9/04 Type of Contract: NQ Date of Death Value (as of 11/23/2009): $37,630.65 All necessary claim forms have been completed by the beneficiaries and proceeds have been distributed. If you have questions, please call us toll-free at 877-880-6367. We are available Monday through Thursday from 7:30 am to 5:00 pm (CST') and Friday from 7:30 am to 12:30 pm (CST). A service professional within the Claims and Benefit Department will be happy to take your important call. Sincerely, ~~ I~~~~ Amber Kerby Claims and Benefit Specialist Claims and Benefit Department cc: File Estate of: Mary M. Guilles D.O.D. 11-23-2009 File No. 21-09-1153 ATTACHMENTS TO: Pennsylvania Inheritance Tax Return Form REV-1511 Schedule H Funeral Expenses & Administrative Casts Dec 21 2009.]2:3?_ Knupp Law Offices LLC 717238'7910 ~LRIlIl~.Rfl ~IIIl.Il1~D'~illl Esta(zlrshed X895 13~ian.C. Musselman, FD. &ep8fvisnf Witliarrt fi. Pagan, F.D. P 0. Box 137 324 fi;~nael AeeAUg Lemoyne, PA t Tp43-0137 (~1~)=T63 7444 To Funeral Expen9es of MARY MARG 4 RET GIIILL~ES Lou Ann Gui.lles r 126 •MeLbaurne Lane Mechanicsburg, PA 17055 2009 Kovembar: 3A Dac.1B,200g. P1tC3F_~FRV•IC~S~FAG>•bITTESr~ALITOS ~-4_,(?-9.0...0.0 Blue "Sterling' Metal Casket 1,900.00 R~=nforcer~ Cor~erete ttat~it ~a50:00 $6, 9-44. QQ cash &dva->~ce Iteurs::- Flowers (inc;tax) $1.56.00 Copies Qf death certif~c~ate: 1.2Q:.Op Paid.t~e.wspaper notices 4499.03 $755.03 (HarrisbTrrg.C2earfielc~b~ H~ungtih}dro-n)~ TO'PAh .-.._.. .............-......... _._.__...................$7,715.03 (Comb. Co. burial allowance) 100.00 SUB--TOTAL ........................................$7;615.EL3- ~ , _. 5ti J~ 4 L ~ ~ ~ 1'~J ~~/ ~; ~ - ~,~ t1 J - t ~ \. . Jeanette Moul Manager ~bk Any ~u i ~~cs (20 l~cr!4ourHG ~k~ ~ ~~~kw: auto µ'/ ~9 !?0 5S RENTAL DEPOSIT: ROOM TOTAL the B~icke~ House -Circa 1909 - 32S Hummel Avenue Lemoyne, PA 17043 717-763-1640 www.brickerkous~com Barbara Musselman Manager INVOICE RENTAL DATE: /Up/e ac ~ ~i 30 2,arxj ~~~ ~~p~ ~~ MATERIALS TOTAL TOTAL DUE: ~ ~,?, Sp °A gathering place for all occasions." Private and Corporate Functions l+ Y J1, ~ (~ ~~ iF j /,t ~. r•"' - ~,° JUICE & Jf ,.nt Cafe' 5258 SIMPSON FERRY ROAD Invoice - __ _ _._ - ECHANICSBURG, PA 17055 Date j Invoice # (717) 691-9000 - __ - _ _ ------------ ---- 11/25/2009 j 7924 _ _ __-- Bill To G---- ------------- ----- - ------ _ _- - --- -- - -- - - __ _ _ -- ncker House 2:30 delivery 11.30-09 Description j Gourmet Wrap Platter Tray(s) California Turkey Club, Grilled Chicken Caesar Salad, Italian with Capicola ham, White Albacore I tuna, Angus roast beef, & Fresh veggie with homemade cilantro bean I Specialty Sandwiches Smoked Turkey, Mediterranean, Classic Club, Albacore Tuna, Balsamic Marinated Roast Beef, & Grilled Chicken on Sundried tomato rolls Homemade soup selections i Fresh cut fruit salad/gallon Delivery, Set-up, & Pick-up I PA STATE SALES TAX '' id ~~ ~~. ~ ~~' c l~ ~_~..I Qty Rate j Ampunt _------6.95 ------------ 97.30T i 6.95 ~ 97.30T 34.9 33.95 5.95 6.oo~ro 69.90T 33.95T ~ 5.95T I s.26 Total-- - __ ____ ---_ _---_- $322.66 J .}~-~ ~ULLIN N GE CAMP - - ~ a.aw. , a~ a~q,~" r~e~rai, nr~ (~10 84847 Contract O~M~ File Folder Name/Number CEMETERY INTERMENT RIGHTS, MERCHANDISE, AND SERVICES PURCHASE/SECURITY AGREEMENT - TATC A!!DDCarc~rm s. The undersigned, referred to m 'Purchaser', hereby agrees to purchue me Interment Rights, Mereltandiae and Services described herein eubjecl to , aeeep4nce and the above named cemetery, hereafter referred [o as'Seller: approvN of Purchaser: last Name: IGI Ill I I L I L I I SI I I 11 1 1 1 1 1 I P"s` L D Middle: I I IUI I A INI /Ill 1 1 1 1 1 1 I I I I I I I Telephone: (~ I~) „ 7 _ _ 4 r S SgN: _ LL f)OH: Email: __ ___ /-/ Address. 11181 fhl e'I Ll t~ul UII21M El I IAI NISI I I I I I I I c'ty IHICICIMIAINI IICINi3lllR(Smte: ~ zip: I~(~ ~ -- Co-Purchaser: Iasi Name. I I I I I I I I I I I I I I I I I I P"st' Middle' I I I I I I I I I I I I I I Telephone SSN. (-)- I I I I I I I DOB: -_ / / Email. Address: I I I I I I I I I I I I I I I I I I I I I I c'tY S ~ te, zi I I I I IIIIIIIIIIIII e'III p' Deceased: Iasi Name: I~ I' I l L I L l' I~ I I I I I I I I First: Ff I h E IL/ 1 1 1 1 1 1 1 Middic: I Doe: rl /~ / ~ q ~? DOD: I i II I I I I I I / ~ ~ Burial Date: Description of Interment Rights to be used: - _ _ ~ ~ O _ ~ Memorial lion Rights: Isme eenidea~e or Imrrmrm Rignts ro. Addrtss. City: Smte: ziv: INTERMENT MERCHANDISE & SERVICES • Inkrment Rights $ - Urn (Includes Perpetual/Endowment Care of $ ) Supplier • Inkrment end Recording Fees - Type/Color • Outer Burial Container ~ Design/Size Supplier Admin/Processing Fee ~'~ (~ ~~~ Model/Design ") /~ Other a rf 1!>c ~~ 1- -'' ~ I v ~ ~ L,. ;SL G,-~ Material/Color • Other _ • Outer BurialCmteiner Installation - Other _ MEMORIALI2ATION Other _ • Memorial Other _ Supplier Other Type/Color TOTALS, ALLOWANCES & TAXES Design/Size IntermentRights ................_ • Memorial Base .........................._................. ( -) _ Reason Supplier Merchandise/Service .................. ( _ ....... - rype/coinr ) ......................... Reason Design/Size Apply to • Memorial Perpetual/Endowmen[Care - Merchandise/Service ................... • Memorial Installation Fee - Reason • Memorial Inspection Fee - Apply to • Nameplate oll ~ A I.P ~ Q ~, ~~ Sub Toml ~ 2. ~F ~ ~ (~ • Lettering _ Total Taxabk • Flower vase - Sales Tax (if applicable) .................................. upplier ... .............. TOTAL CASH PRICE $ ,'?(/ ~ [.^ Type/Color Less: Down Payment o- ~ (f S G~ Design/Size . Other • Vase Base - Total Down P. ( ~~ yment '~4 ~ Size/Material . ) , , Unpaid Balance of Total Cash Price $ i~ Notes & Payment Terms (where applicable): _ TERMS The Total Cash Price is due and payable as of the date of this Agreement. A delinquency charge of _ percent will be assessed monthly on any balance not 30 d id f h i hi ays o t e date of this Agreement. If less than pa w t n full payment is received, Seller shall deduct the accrued delinquency charge from the amou t i d remainder of the payment to [he Unpaid Balance. n rece ve end credit the Security Interest: Seller (or its assigns) will have a security interest in the Interment Rights and Merchandise being purchased as described above Selle ill id I i sa nterment Rights and Merchandise until the Total NOTICE B i i . r w reta n title to Cash Price, together with any delinquency charges thereon, have been paid by Purchaser to Seller . : y s gn ng this Agreement, Purchaser is agreeing that any claim Purchaser may have against the Seller shall be resolved by arbitration and Purchaser is giving up his/h<r right to a court or jury trial as well as his/her right of appeal. PRENEED COUNSELOR SALES RECEIPT R©LLING GREEN CEMETERY CGiviFANY 824 No.0007799 1811 CARLISLE RG CAfviF HILL, FA 1701 i 717-761-4055 1 DATE RECEIVED FROM 1~ y y ~~ i ~~ Q D~ nanN of Pumhaaar ~~ ~ `~'I ~o L .9 J D THE AMOUNT OF_ ~1 ` tNCd'T.f~_ DOLLARS 15 ~3~ft~ ~ ) AS: DOWN PAYMENT ^ REGULAR PAYMENT ,^ CREDIT CARD CHARGE ^ CASH ^ CHECK LIy CARDTYPE ^ FORTHE PURCHASE OF INTERMENT RIGHTS AND/OR MERCHANDISE AND SERVICES FROM THE ABOVE NAMED CEMETERY. RECEIVED BY CEMETERY SALES COUNSELOR DATE BY NAME - / GEN 9002 (6/02) ' I ~ T % -'~ Deb 0' ~0'_C '?:08 Knupp maw Offices LLC E~~upp .~.aw ~~ice~, ~.i_~ F~C7 fox 63Q X17 Aka~ttt Fr-o~t S~ceef F~ac.rishux$r PLC ~C~'~-Q~-Q~3O Flat ?1?23B?810 p.4 ~,D41P.f1A~_ S,OCC.~ MARY M GUILLES 1014 LOU ANN GUILLES 100 MOUNT ALLEN DR RM 212 r 60-tv3ista MECHANICSBURG, PA 17055-6171 ~~~` ~~~ oas Dace Paq to the / // 11 OL' Order of ~~I'1Lni~(~ ~ CUB' ~`r~ C ~ C...L<~ ~ ~ .~~ VU~ I/C3~ Dollars ~ ,,, ~'1VCB~il\IK ~~. PNC Bank, N.A. 040 Central PA f~ ~~ ~ , For ~ ~ l.C.ly / ~ -G1' ~ '~~ ~ ~~ ~' ~ i~C~~/".~~ m~ ~:D 3 L 3 ~ 2 7 38t: 5DD 5D 594H` II^ LD 14 I, 71::238-71Si ~. 7ir?38-~}E~ ~ ~aben.knu~p~u~==~~ nP* ~~ ~,~, - ~j .' ~~~'i~ ~~ RECEIPT FOR PAYMENT GLENDA FARNER STRASBAUGH Rece_Lpt Date: 12/14/2009 Cumberland County - Register Of Wills One Courthouse Sgware Receipt Time: 15:41:31 Carlisle, PA 17613 Receipt No.: 1059278 GUILLES MARY M Estate File No.: 2009-01153 ~~~~-/JO( Paid By Remarks : LOU ANN GUILLES ~ ®~ /~~ ,,~I,,CC~~~~ DM ~-- ~ u/" -----------" '--------- Receipt Distribution ______________ ---------- Fee/Tax Description Payment Amount Payee Name PETITION LTRS TEST 410.00 CUMBERLAND COUNTY GENERAL FUN WILL 15.00 CUMBERLAND COUNTY GENERAL FUN SHORT CERTIFICATE 48.00 CUMBERLAND COUNTY GENERAL FUN JCS FEE 23.50 BUREAU OF RECEIPTS & CNTR M.D AUTOMATION FEE __------__5_00_- CUMBERLANI) COUNTY GENERAL FUN Check## 1012 501.50 Total Received......... 501.50 ~ ~ ~l e~~~'" C'~~! PAC f~~,y~oy ~;. I ~~c~«Ters ~ ~~~vTers Certified Public Accountants Richard H. Flowers, II, CI'A Thomas H. ]a lowers, CYA MEMBERS oFAMERICAN AND TENN51'LVANIA 1NST'ITLITES OF CERTIP'IEI~ PUBLIC ACCOUNI_ANTS 5", 75 ALLENTOWN BLVD., SUITE ] U? (7171 652-6069 FAa f717) 652-715(! HARP,ISBUILG, PA ]7112 WEB SITE «M~w.FlowersCPAs.con. FebruarS~ O1, 2010 Invoice submitted to: Estate of Mare Margaret: Guilles C/0 Lou Ann Guilles, Executrix 128 Melbourne Lane Mechanicsburg, PA 1705 Invoice ~ 3006G FOR PROFE5510NAL SERVICES RENDERED Progress Billing: Preparation of PennsSrlvania Inheritance Tax Return Form Rev-1500. Amount ~ r, 500.00 IIhARY M GUILLES LOU ANN GUILLES 100 MOUNT ALLEN DR RM 212 MECHANICSBURG, PA 17055-6171 1015 ~~ `. ~~ / ~ 60-ID3/313 046 /~ ~ ~ Dollars Pay to the Order of ~-- ~ n ~. ®~ PNCBANK ~"'~.~~ PNC Banly N.A. 040 / / Central PnA / ~ 9 For _ ~ ~ ;, /(~/ /. l/ ~) ' nm ':D3 ~3 ~ 2738: 5D^5D59~,' S11' 10 ~5 Nene~e cr.ke Flowers & Flowers Certified Public Accountants Richard H. Flowers, II, CF'A Thomas H. Flowers, CPA MEMBERS OF AMERICAN AND PENNSYLVANIA INSTITUTES OF CERTIFIED PUBLIC ACCOUNTANTS 5775 ALLENTOWN BLVD., SUITE 102 HARRISBURG, PA 17112 December 16, 2009 Estate of Mary Margaret Guilles Lou Ann Guilles, Executrix 128 Melbourne Lane Mechanicsburg, PA 17055 Dear Ms. Guilles: (717) 652-6564 FAX (717) 652-7150 WEB SITE: www.FlowersCPAs.com In order to document the understanding between us as to the scope of the work that Flowers & Flowers, CPAs will perform, we are entering into this Agreement with the Estate of Maly Margaret Guilles. To avoid any misunde]•standings, this Agreement defines the services we will perform for the Estate as well as the Executrix's responsibilities under this Agreement. PROFESSIONAL SERVICES Flowers & Flowers, CPAs will perform the following services for the Estate of 1Vlary Margaret Guilles: 1/ • Prepare the decedent's fina12009 Federal and Pennsylvania individual income tax returns. Forms 1040 and PA40) ( Calculate a prelilninar,~ estimate of tl~e Pennsylvania Inheritance tax obligation for the purpose of providing guidance to tl)e Executrix in order to make an advanced tax payment within the discount period. (by February 23, 2010) • Prepare tl)e Estate's Pennsylvania Inheritance tax return. (Form REV-1500) • PI•epare the Estate's Federal and Pennsylvania Fiduciary income tax return f)1• the fiscal year ending October 31, 2010 (FoI•ms 1041 and PA41) • P]•ovide consulting as needed with regard to above listed services as well as ;any othel• issues at the discretion of the Executrix and/or other professionals or agents engaged by the Estate. We will also provide consultation or assistance to your legal counsel and/or other professionals you have engaged. You agree to maintain legal counsel to assist us with any legal matters l:hat may arise. Tlie taxing authorities can review your returns, and any items resolved against you are subject to certain rights of appeal. In the event of such an examination, we will be available to represent you. We will bill you separately for such services. Our work in connection with this engagement does not include any procedures designed to investigate other tax liabilities and the application of other tax laws to the Estate. However, you Inay request that we perform additional services not taken into account by this engagement letter. If this occurs, we will communicate with you regarding the scope and estimated cost of these additional services. Engagements for additional services may necessitate that we issue a separate engagement letter to reflect the obligations of both parties. In the absence of any other written communications documenting such additional services, our services will be governed by the teens of this engagement letter. YOUR RESPONSIBILITIES We will prepare tl~e Decedent's and the Estate's above described Federal and Pennsylvania income and inheritance tax returns from the information furnished by the Executrix. We will not audit or otherwise verify tl~e data submitted to us, altl~ougl~ we may ask, if necessary, for clarification or additional information. The information submitted to us will, to the best of your knowledge, be correct and complete, and will include all income, deductions and other data required for tl-ie preparation of the tax returns. The Executrix is responsible for keeping necessary records of deductions and any expenses. In preparing the Estate's Pennsylvania inheritance tax return, we will not independently determine values, except where tl~e values are able to be determined by reference to market quotations contained in tl~e Wall Street .Iourial or• equally reliable sources. We will discuss with you other items which pose valuation and /or supporting documentation issues and you agree to obtain and provide to us such other valuation appraisals performed by outside, competent parties and /or supporting documentation. We reserve the right to withdraw from our engagement in the event you are unable, or do not obtain such appraisals or supporting documentation. We will use our judgment to resolve questions involving application of tax rule:; in the Estate's favor if there is reasonable justification for support of the position. We will be availablc; to answer your inquiries on specific tax matters and to consult with you on income tax planning. The law provides various penalties that may be imposed when taxpayers understate their tax liability. The Internal Revenue Code and regulations also impose preparation and disclosure standards with non- compliance penalties on the preparer of a tax return and on the taxpayer. Accordingly, we will discuss with you before completing preparation of the returns, tax positions that may increase the risk of exposure to penalties or subject us to preparer penalties. If we fail to reach agreement on a tax position, or disclosure of that position on your return, we reserve the right to withdraw from the engagement without completing or delivering tax returns to you. If you would like information on the; amount or circumstances of these penalties, please contact us. If you are liable for estimated taxes in the subsequent year we will calculate the estimated payments based on tl~e information shown on tl~e current returns, unless requested otherwise. OUR COMMITMENT TO QUALITY As members of the American Institute of Certified Public Accountants, we participate in their mandatory peer review program. The program requires that tl~e quality control policies and procedures of our accounting practice undergo a review by an outside CPA firm every three years. This program is designed to ensure that our clients are receiving services in accordance with quality control and professional standards. We are pleased to inform you that we received an unmodified opinion on our most recent peer review report. FEES Our fees for• providing the services described above will be $9,750.00. We will bill you on a periodic basis as work progresses. Our invoices are due and payable upon presentation. PRIVACY POLICY Enclosed for your information is a copy of Flowers & Flowers, CPAs' "Privacy Policy", AGREEMENT We look forward to providing these services and shall be pleased to discuss this letter with you at any time. If the foregoing is in accordance with your understanding, please sign the copy of this letter in the space provided and return it to me. Sincerely, ;: ~~ . Richard H. Flowers, II Acknowledged: •.. ~ a Lou Ann uilles, Executrix / Date RETAIN THIS PC-RTIUN FUR YUUK Ktt;uKU~ THE SENTINEL - LEGAL P.O. BOX 130, CARLISLE, PA 17013 I(Njjpp ~y~ O:~'FICES , LLC AD NUMBER CLASS SALESPERSON BILLING DATE LINES 378854 10 PUBLIC NOTICES wo:lfc 01/:12/10 30 * 2 AD DESCRIPTION START DATE STOP DATE NOTICE NOTICE IS HEREBY GIVEN THAT 12/29/09 01/12/10 PUBLICATION INSERTIONS RATE 3 THE SENTINEL - LEGAL NET AMOUNT GROSS AMOUNT 3 LGL :159.30 TOTAL AD CHARGE ~ :159.30 3 PROOF OF PUBLICATION / 01PRF 7.00 YS RUN DRDER PAY THIS AMOUNT Est.MaryGuilles 166.30 199.56* MESSAGE: Thank you for advertising with The Sentinel. Deadlines for in-column legal advertisements: Monday is Thursday at 5 p.m; Tuesday is Friday at 5 p.m.; Wednesday is Monday at 5 p.m; Thursday is Tuesday at 5 p.m; Friday is Wednesday at !5 p.m Saturday is Wednesday at 12 Noon; Sunday is Wednesday at 5 p.m. If you have any questions regarding your Legal bill please call Classified Manager at 717-240-7176 Fax your legals to 717-243-3754 attention Classified Manager You can also EMAIL your legal to Classified ads: classified@cumberlink.com Please send a cover letter including your name and address as an attachment CUMBERLAND LAW JOURNAL 32 SOUTH BEDFORD STREET CARLISLE, PA 17013 Tele: (717) 249-9188 Fax: (717) 249-2883 January 22, 2010 Cumberland Law Journal is published every Friday by the Cumberland County Bar Association and is designated by the Court of Common Pleas as the ofFicial legal publication for Cumberland County and the legal newspaper for publication of legal notices. TO: Robert L. Knupp, Esquire RE: Mary M. Guilles Estate Legal advertisements must be received by Friday Noon. All legal advertising must be paid in advance. Make all checks payable to: Cumberland Law Journal. Advertisement inserted on the following dates: January 8, January 15, and January 22, 2010 Advertising Cost $ 75.00 ' Proof of Publication $ 0.00 ~ ~~~ ~ Second Proof Request $ 0.00 Payment received $ 0 .00 Total Amount Due $ 75.00 Payment received by Estate of: Mary M. Guilles D.O.D. 11-23-2009 File No. 21-09-1153 ATTACHMENTS TO: Pennsylvania Inheritance Tax Return Form REV-1512 Schedule Debts of Decedent ~~~~' 100 MOUNT ALLEN DRIVE, MECHANICSBURG, PA 17055 .~~ MRS. MARY M. GUILLES 212 MESSIAH CIRCLE MECHANICSBURG, PA 17055 Xt. 1 ~.. ~- .~> Form PB-01 QUESTIONS?:CALL: 717 697-4666 RESIDENT~# UN1T - STMT.DATE 50908 031 D 10/31/2009 :RESIDENT(S) Mrs. MARY M. GUILLES TOTAL AMOUNT.DUE '' $17,686.00 DATE UUE 11/30/2009 .DATE 'DESCRIPTION' ~ RATE Days/. unity: CHARGES CREDITS BAL:AN~E Balance Forward 3,630.00 10/20/09 PAYMENT RECEIVED -THANK YOU!!! 3,630.00 0.00 10/31/09 MEDICARE PART A CO-INSURANCE ~ 7,906.50 7,906.50 * * * Assisted Living * * * - 10/31/09 PS2 - BRANDYWINE SINGLE 130.00 31.00 4,030.00 11,936.50 10/01-10/31 *** Nursing Care *** 10/01/09 MEAL CREDIT -9.00 31.00 279.00 11,657.50 10/15!09 BED ALARM PAD 57.00 1.00 57.00 11,714.50 10/15/09 CHAIR ALARM PAD 45.50 1.00 45.50 11,760.00 10/15/09 TRANSPORTATION 35.00 1.00 35.00 11,795.00 Dentist, St. John's Church Rd, Camp Hill 10/20/09 TRANSPORTATION 35.00 1.00 35.00 11,830.00 Dr. Dailey, Center St, Camp Hill 10/30/09 TRANSPORTATION 30.00 1.00 30.00 11,860.00 Dr Rosso, E. Trindle Rd, Mechanicsburg 10/30/09 PREVAIL PROTECTIVE UNDERWEAR 1.30 20.00 26.00 11,886.00 10/31/09 RM/ BRD -NURSING -SEMI-PVT 286.00 20.00 5,720.00 17,606.00 10/12-10/31 10/31/09 AIR MATTRESS 10/12-10/31 4.00 20.00 80.00 17,686.00 ~o~,~- s~p1e;~, er~~-o-~ ~~su,Y~f~~e, - Ccvp', 4-c~-~ 3t~.e Cross MCP " . vn 1,.~ ~S -~ ~ \ O ~-c,~,~ S o ~ CCU- ~h S c..irc.~.~ e. RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 50908 9,779.50 4,005.00 3,901.50 0.00 0.00 $17,686.00 RESIDENT NAME Mrs. MARY M. GUILLES FormPB-Ot N/A A 1% finance charge may be assessed on accounts for which payment has not been received b}~ the due date. Thank you! If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You! BAS SES Y/CE Billingg Summary for Service to: MARY Tvl GUILLES LOUANN GUILLES B07 ROSEMONT AVE NEW CUMBERLND PA 17070 Rate Classification: Residential General Billing Period: 10/27/2009 to 11!1712009 (21 days) Final Read Questions? Call 800-276-2722 or write to UGI at PO BOX 13009 Reading, PA 19612-3009 "Your current UGI charges include State taxes totaling about $ 0.28. Past BIII Information -UGI Utility ~~ ~ ~ ,r ~ `. `'; The account balance on your last bill was ................ $ 13.16 Thank you for your payment of ..................................... -13.16 213 144 3756 09 Your balance as of 11/19/2009 ...................................~~ba Current Bill Information -UGI Utility Customer Charge ........................................................:..... 5.99 Commodity Charge (2 CCF at $0.91500) ................. 1.83 Distribution Charges ........................................................ 0.86 PA State Tax Surcharge .................................................. _ -0.02 Total Current Charges -UGI Utility ............................... 8.66 UGt Utility charges owed this bill ......................~........................................................... $ 8.66 Total Amount Due, Please Pay by Due Date (12/10/2009) ..................................... $ 8.66 Meter Reading Information Meter Number Previous Reading Present Reading CCF Used 1356870 356 (remote) 358 (final) 2 Messages from UGI '^ Your current price to compare is $ 0.91570 /CCF. '^ Your total annual usage is 75 CCF. Your average monthly usage is 6 CCF. '^ Thank you for your business. You have maintained an excellent payment history with UGI. This bill may be used as a credit reference for obtaining future utility service. ^ Help prevent pipeline damage, accidents and service disruptions. Call 811 before you dig. I(~~ ^ Your bill does not display a usage graph because your average daily usage is too low. /~/ ~ ~ ~ (?~ (~ O ~~ If you pay at a payment agent please take your enfire bill. Make check payable to UGI. Keep this part for your records. Important information is on the b9ck of this h'~~ N m 0 0 PPL Electric Utilities Electric Service For: MARY M GUILLES 807 ROSEMONT AVE NEVJ CUMBERLAND PA 1707() Questions about this bill? Please contact us by Dec 1 ] at1-800-342-5775 (1,800-DIAL-PPL) or write ta• Customer Service 827 Hausman Rd. Allentown, PA 18]04-9392 www.pplelectric.com Electric Use This graph shows your electric use over the last 13 months. Types of Meter Readings: Actual . Adjusted Estimated Customer ~i ~ ~ Y ~ b b '... _ •._ ••'_ F.. ` . ,w Summary Page Page 1 - ~i;~i:;iI';N3£'$ilIa~CGtA3CIfi:~Ti1[X16F,Yi:i~iii::~.ji: 96601-27005 Balance as of Nov 2Q 20(19 $U.OU Char es: Tota~'PL ELECTRIC ITTILITIES Charges $17.33 To1a] Charges $17.33 . .:;: :?~:'~'tft8„t~,Q~ln$#it~.a't~r"thxa;l~ec~~,:....... .... ~~7.3= Account Balance $17.33 24 20 16 12 8 4 0 KWH -Average Per Day DJFMAMJJASOND 2005 Months 2009 Meter Reading Information Meter #60376287 Nov 20 Actual 37888 Oct 29 Actual 37784 ZZ Da s KWH Billed 104 Average -Nov 2008 2009 Te~__m~~~pp~erature 44F KWH P D 1 SOF er ay 4 5 Yearly Use: Total Average Use Monthly Dec 2007 -Nov 2008 5458 45~ Dec 2008 -Nov 2009 4056 338 Other important information on back 3 Customer Account Information For Service To: B Guilles 807 Rosemont Ave Account Number: 24-0624480-2 Premise Number: 24-0369182 Billing Period & Meter Information Billing Date: Nov 24, 2009 Billing Period: Oct 30 to Nov 20 (21 days) Next reading on/about: Dec 02, 2009 Rate Type: Residential Meter readings in current billing period: Meter Number N042094785 is a 5/8-inch meter. Present-actual 349800 Last-actual 349600 Gallons used 200 Water .Usage Comparison Monthly usage in hundred gallons. 2 iN °D J F M A :M -J J >A :S O -N "2 p o e :a 'e a p 'a v u :u a .c o '0 :v c n ".b .r r y n I g p t v 8 9 AMOUNT DUE --------------------- ~~~ $13.43 -13.43 .00 8.87 .45 1.05 10.37 $10.37 1 Messages to you from Pennsylvania American Water This Is your Final Bill for service. t has been a pleasure serving you and we hope we may again have the opportunity in the future. Approximately 3.90 percent or $.40, of State taxes are included in your current bill. Save time and money by signing up for Pennsylvania American Water's automatic payment program. Your bill will be paid directly from your checking or sarongs account. 'Have you moved or changed your phone number? Please let us know, so that we can update our customer records. To update your information, call us toll-free, 24 hours a day at 800-565-7292. Effective October 1, 2009, the Distribution System Improvement Charge (DSI(~) increased from 4.68% to 6.07%. Customer`Service & Emergencies 1=800-585-7292 (24 Hours) ForHearing:Impaired Customers TDD 1-800-300-6202 (24_Hours) Visit us on the INTERNET: ww.w:pennsylvaniaamwater:corn RAW I0DAM1681AM2111 Billing Summary ----------Prior Balance----•------------------- Prior Water Balance Payments prior to Nov24, 2009. Thanks! Total prior balance, Nov 24, 2009 ----------Current Water Charges---------- Service Charge Water Volume ($.002250 x 200) Water Volume ($.005250 x 200) Total Usage Billed o /~ r, ~ li I ~ U il" ~ io~° -:000186/000186'PCJZ3A~TA708t23 ' A1M :23809 ~~ /~ MRR'Y Gt>~LES Account 5uttnfrtaFY Prerfdus Charges ~l&2:25 Na PeyrryentReeeiated . -- _-__OD Past Iiuo Charges please pay-nowj ~ 862.25 eit~ ~ -t2ti ~ -~t -~ s Telephone Number : 717 697-2957 RaroucstM1lucrttrac:. 717.6$7-2957 233 39Y.. S !e •~. Yeriz~rtJ?errer Mo-1rr1R'Easl-. With one ca!!lo i-888-StaT268 Vesizon Cart ttel/1 set up your 7-V; 1MerneYrY:phoneat ynurneyv titldress: Call today and ask it Yerizon F1OS is available is your homa. •Lct Verizon take the vwrry out of setting up a-l~youreritertainrrtent services... SCN1GS evelleWUty verbs. ii s~ Piosso pay upon receipt tNe W+mt-You ro Stay. rrlNet- t/a You are a valued customer & rre want to - RNAL BILL - l $i!F ri-ay have already: beer~re[erceYtt~ art ~~rsrt,. ~etivrr Fi i T .deliver the.vary.hest servroe & value na s h to-you. Callus at f-1388-&f0.~8z5trr agency. pay your.bili onVine at vetizan.cocn/payfmalbill find out about the new ways Vernon cac: ire yoa•rnon~mertey We appreciate ' being your provider, and we would !!ke lo..keepyouwifh us longer by rn}proving y©ur Vetrznn e;'ipe~rve. Nrw Charges __ __ VefiLOrt (page"3~ _ $-48.72 Total New Charges Due _, - $48.72 Total ffua ., Get More, Save Morn t]uee+lie+~'s aboel yr~b>t{.?• . Vrsit verizon com or call 1-etX?-VEF~fZDN ('t-SOa-8~7-49~Y Charrgo tsttriltingaQdrsss? Go to verizon com/billingaddresa or call us. Catt.t-tl@~.6! 0-928t}fo rrraNe-~ you're getting the tress Verizon services at the best value -from phorteancllriteniet, ld7V and moneyr- saving bundles. ;~ogethe~ We71 eratttate-gourcurrErlF 9ewfcee, and frnd ways to save you , even more. ~ Detactl & Feturn p3ythettt SNp witkt your check, payeblEtave~t. ~- . -- plgpSE E CLOSk THIS Pux i.•,•. ,.. - - ~.-- AIWRY M GUILLES 212 µEc,,SIAH CtR KAEGH~~$~G' RA i?fl5~'t9 Prea9e acAe ~ accot~t. numh~.cmY~ °~k °f monk' oar to ~1°~ PTOPa credit to yw+f a~°~ i ~ EPROPER CRgDl'C TO YOUR ACCOUNT a;S - A436 ' ~y1$P a ~_RS.2AD9 gmount Make payment 'Far 11t~t~t,~l~}~1~1-,~~t~~,~lll~{1~~f 1~~Itldd~~t11~1t,fl~ltlil WEST•ASSET Mpr1AGE P a. Sfax 9~6>~Z . ST.. LOUIS, MO 63195 pflaa18'~bgs119 Z ^pOpptl3$116 y31~y7012825 4 p1 pp000 Dec 21 2009 12:29 - _ Dec 21 2009 12:30 ICnupp Law Offices LLC 7172387810 p.4 7` .~..~. :,,. r .~~ 100.1UO.UNT ALLEN DRIVE, PQECNRNtC9til1R&• PA '17055 QUEST.10t~1S? CALL: ._ (71'~ 697 SQ908 212 1 DAT€ ~T/a5l8!~ 1tC38~~ I~ llt3~~ 111-1x3184 LOU ANN G11ILIrES- 128 MELBOURNE ~,AFA 17fi5~ - MECHANX CSSUR'Gz D~SGRIPT~31~i Be~a,~- ~'S~MEN'F .~~.'~ED - ~giAi+IK Y QI]! ! ~ *** Assisted Living *'~* PS-Z - BRAI~Q~`~~ S~N~'LE 11/01-11!30 lt~t.CAL CRED~'F *** Nursing Care *** 1VI.rs. MARY M. GUILLES TQTA MAL OUNT DUE 12/31l20B'~ PATE DUE ' CHARG><& . CR~ptTS $,t<<,{tNCE T.E.. ~a ! 17,b8~.Of- 1'7,686.00 0•~ 130.00 30.40 3,980.00 3'900.88 -9.00 30,00 270.00 3,63~Oi 30.00 1.OU 30.00 3'~ Health South (!:r•ism), L~~ gA t 1.3R ~:0@. i r t e i t r ~ ~/ ~.. -:` > YET .r, ~ F' FI r / ~ ' `` ~, - :J rI f'~~ ~sr. r ~ i'r-~~ ~' f1 S J ti. c ~~ r ~ _ . r F/ r _j ~/~ /c , rte, F / ~ r \ . ~ F f ~ _*~ '~/ ~~. ' F &1 ~~ V ~F C, 1r `;H S~ t / J 'r F r , ° .Y ~ - ': i:-'^ ~ t_"~L'~+~^~,,~5• 4] wr~.~ a ~~ ' ~ - `` it ~. 1~ `tt ~, \\ r ~ 1. r \~~ _ _ ' 1 `. !r, ~' `(l 4 rF R~a~}p F" 'F _ . I,T~~~~ /' ~)4 T WI+~~~~t ` ~, r / ~ l / ti r \' 1. __ : - - .. - ~ ~ ' . _ O~E~~y OVER 90 OVER 120 TOTAL AMOUNT SUE CURRENT ~~ ~•4~ $1~.(;<Q6.r3Q RESIDENT # 0.00 ~.~~ 0.0$ ~n~yilD 1~~vQy•JO Fo~xe1 P8-0S irl' V V N/A - . RESipENT NAME Mrs- MARY M. GUII'~'EQr.~~nnt been received by the dne date. Thank youi A 1% financr charge ~eY ~ ~ ~ ascv~s n~-~ncerns abo~rt~our'bi1t~'P~a addressthem directly to Fiscal Services at 790-8224. Thank You! If you.issYeany~q Dec 21 2009 ].2:31 {<nupp Law Offices LLC 71723Bi910 A 8Ia1R1WC8 ~p8 OP 1.50 k FSR Md3~1'PK P gg'~tT.:. 3;Ii~ . f7~ .g,A,6S -.xZTS-dt 1H . uu f oa A 2pR AlLLTIElO3i8 A1Tg~~ B~YICS ~~ ~' ~ 1.00 ~i?S.L+ ~ ~~ ~ ~~Y sPRI~.' ~ ~, a a nh~cs o~-: BRST ot18 ~~: eoo-ash-~95~ PMT DRJB". , 12/24/03 30 PAYS. 312.56 ~ ~; 6.u- 90 DAY6. lba.03 nanrTVR ZL ~i81i ~ l'~n ~~ FOR iPR'66QtIPT1E~ ER- 69fi~'rQ . ~Uf~3F g8- ~-A-Cllp'Y , a~rn~c., OIIILL&S, MARY E~-~ ~eszax v~wr.~~$ gaps z 243 -. Pik 1 ~Q~S~` p~~-C'Y g$&V . INC .219 IZO~TH g~,TIMDRB RV'B, tRT . ~~Y ~ ; ~" 17 0fi5, RIABT p.5 - _____,_r~--~-r i - Y ~L1r'.~~T'~ ~ ). ~~`~,. ~'L1 f H (r'•' Lrn~~~[.j` • ~y~pp ~.~.Il~ f f ~CII~C ! , .i L- I l t~ S 1, ~~~< ,. ~ . r, r ~: /,'a 5 . ~ ~ ~ 1 r S f l / t ! , '~~J.1/us/uyJ 032/~16J~. l.• 11/OS/03 7600919, 6 .11/21/~ gi1T962 I ~, , . ai IQ1Rg~ 3 ~ of i. Ad >~T+r+~-F'f 10-I:5'L 24:45 LRCa~'N P70mi-LEtil~: PE3& l1C~- FOR b~DN'rH 6.08.26 .00 ~.ea:~a za~z. ~ . . afl _Op 1,80 .oa .ssc ,po 1.80 .dd $DB.a6, _... _.-.. i •••-•~•.. I Ilrtl}c I v~v~~~~;a ~.a I vnc/1IO ~ .... vL' Balance Forward 10,046.50 12/23/09 PAYMENT RECEIVED -THANK YOU!!' 1.0,046.50 0.00 12/31/09 MEDICARE PART A CO-INSURANCE 30.00 -30.00 *** Assisted Living *** 12/06/09 PS2 - BRANDYWINE SINGLE 130.00 6.00 780.00 750.00 12/01-12/06 12/06/09 MEAL CREDIT -9.00 6.00 54.00 696.00 d J ~ ~ , ~° RESIDENT # CURRENT OVER 30 OVER 60 OVER 90 OVER 120 TOTAL AMOUNT DUE 50908 696.00 0.00 0.00 0.00 0.00 X696.00 RESIDENT NAME Mrs. MARY M. GUILLES NIA PB•01 A 1 % finance charge may be assessed on accounts for which payment has not been received by the due date. Thank you'. If you have any questions or concerns about your bill, please address them directly to Fiscal Services at 790-8220. Thank You! ~~. :.~:~* _ ~ .MARY ___ ..:____ -~C~~~FZ'~ FOR--GUI~DLFrS ;- ~..._.--GI?~IhM-- 5-_~- w._'5~09.Oig.:_ '.. _.:oo _w .: ._.3 1 .11/06/09 7.57.8.614 27 POTASSIUM CL 10 M O1 3.5 .55c 11/06/0.9 60421 7.5 7 OMEPRAZOLE 20 MG O1 1.08 .OD 1.0.8CI 1/06/0.9 •1 . 7589023 7 LIDODERM 5% PATCH O1 12.69 .00 12:69~' . 1:/06/'09 7560430 26 SENNA LAXATIVE O1 * 3.05 ..00 3.,05 'I 11/0.6./09 7560432 6 SIMVP,STATIN 20 MG 01 .53 :00 .b3C~ ~ 1"1/06/09 7571745 8 THEREMS-M TABLET 01 * 2.79 ..00 2.'79: I 11/06/0'9 7606146 7 VENLiAFAX2NE 37.5M O1 1.9,6 00 1..~9,6C' ! 11/0'6/.09 760324:9 7 SERTRALINE 25'MG O1 :46 .00 .4.6C 11/06,/D9 76,03'9:55 6 MONO NTTROFURAN 1 ~ Ojl 2.22 .:0"0 2.22C1 '11/06'/09 7600372 6 RI•SPERIDONE '0.25 O1 1:84 .00 1.84.e) 11./'06/09 7586679 7 DIOVAN:B'0, MG 01 4.67 00 4.67.0 ``11/'06/09 75'8;4591 13 METOPROLOL .25. MG O1 .47 .'0:0 .47e 11/10/0;9 76'03,709 21 FLORASTOR :250 MG 01 * 17:;:79 .'0.0 17 r79, ,; 12/'22/09 Pa. ent-Thank. You Ym 6- 60.8:2, .00 60'8.26-I . ~~.: ~ , !`V~~ ~ ~,e,,,.... ~~, .. ~. ---------- ------------ --------- I I ------ -----•------------- -------...---------------------------- ----~ . 0 0 - 2:9.47 23.63 ~_ LEGEND .NON-LEGEND .- ?oTA-Taz _ _ __ _ _ _____ ~~t~mu _ _ AMOUNT DUE ~r'evious'Ba'lant:e Charges this month Finance Charge TOTAL CHARGES-~ Total PgymanfB Credits - _ i + + 608.26 53..1,0 .00 661.36 60:8..26 i 53.10 FOR ALL''iPH~RMACYrRELATED:INQUIRES:PLEAS~.C/ALL'Alert Pharmacy Services, Inc at 1-800-266-9954 SietemeniTerminologyon'reverse _ ______~~